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

1. Managing Holiday Fatigue -
An Integrative Medicine Approach
Enrique Saguil, MD
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

2. The First Health Approach
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

3. • Legal release: I am in not receiving any financial reimbursement from Whole
Foods Market. The names in this lecture have been substituted to protect the
innocent. The recommendations in this lecture are not a substitute for health
and wellness, please see your personal physician.
• To get copies of this
lecture, please contact me at:
www.firsthealthassociates.com

4. Your Team
Ric Saguil, MD
Jason Gruss, MD
Tom Jordan, RD
Katrina Christie, LCPC
Mike Blumburg, LCPC
Jennifer Green, ND
Joe Musolino, DC
Amy Iaquinta, DC
Emery Paredes, PT
Courtney Day, EP
Aimee Weber, EP
Yu Zhu, MD China
You

5. Ric Saguil, MD
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

6. Defensive driving helps!!
Be mindful on the road all the time
Don’t spend a lot of money on courses
Maintain your car

7. Defensive medicine hurts!!
Pay attention to the patient story
Don’t order with sole intention to defend
Help initiate change before disease shows

8. Patient “Amy”
• Low energy/fatigue
• Depressive symptoms
• Poor concentration
• Weight gain
• Constipation
• Brittle nails
• Scanty periods

9. Ruling out Death for Amy
• Bowel obstruction (tumor)
• Liver disease (hepatitis)
• Uterine disease (thickened endometrium) with
resultant iron deficiency
• Thyroid panel testing (with dysfunctional hypo)
• Anemia work up
• Behavioral tx

10. Patient “Bob”
• Midday fatigue
• Weight gain
• Hungry all the time
• Irritability with stress
• Reflux
• Depression
• Alcohol use
• Erectile dysfunction

11. Rule out Death for Bob
• Sleep study for apnea
• Scope for reflux and Baretts esophagus
• Psychiatric eval for major depression and alcohol
dependance
• Liver study for alcohol damage
• Heart scan for heart ischemia
• Check sugar
• Nutritional coaching

12. Patient “Chrissy”
• Low energy/poor exercise tolerance (new)
• Fast heart rate/palpitations
• Diarrhea
• Reflux
• Irregular and heavy periods
• Insomnia
• Poor concentration

13. Rule out Death for Chris
• Stress test for heart disease
• Echocardiogram for cardiomyopathy
• MRI for brain tumor
• Endoscopy for barretts
• Ultrasound for uterine disease
• Hormone testing for menopause
• Nutritional coaching
• Pap
• Counseling

14. Patient Dave
• Generalized fatigue
• Weakness
• Poor sleep
• Muscle/joint pain
• Depression
• Poor memory
• Reflux
• Poor sleep/snoring

15. Rule out Death for Dave
• Rheumatoid work up for autoimmune
• Psychiatrist for depression
• MRI for brain tumor
• Upper gi or endoscopy for reflux
• Sleep study for apnea
• MRI
• Physical therapy
• Counseling

16. Patient Eric
• CEO
• “I’m fine, no stress – just fix my sleep doc”
• 60 hours a week
• Strained love life
• Poor sleep and alcohol dependance
• Needs a lot of coffee
• Obsessive short temper
• Erectile dysfunction
• Reflux

17. Rule Out Death for Eric
• Watch for heart disease
• Treatment plans
• Counseling
• Relaxation suggestions/activity
• Sleep/Circadian reset

18. “Within every ailment is
the answer to it’s cure……..

19. Fatigue could be everywhere and part
of every disease…..?!?!

20. Dr Saguil Approach:
• Establish the basics of
• Proper nutrition (American diets suck)
• Proper exercise (only stressed in high school)
• Proper “grounding” (not stressed at all)
• Proper sleep (de-valued by coffee generation)

21. Ric Saguil, MD
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

22. 1
Why Nutritional assessment
• Deficiency due to Standard American Diet
• Deficiency due to alcohol
• Deficiency due to prescription meds
• Deficiency due to soda and candy (fructose)
• Deficiency due to disease
• Education is lacking or “info-mercial” quality

23. Top Dietician Tips –Tom Jordan, RD FHA
1) Balance Blood Sugars
2) Stay Hydrated
3) Nutrient Timing
4) Prevent Vit/Mineral Deficiencies
5) Eat Good Fat
6) Think Holistic
7) Additional Testing if Needed
*Consider an individualized treatment plan—because there’s no “one size fits all”
approach to optimal health!

24. Macronutrients have power
• Proteins in am
• Carbs in pm
• Water in between
Thanks and Good Night!

25. Absorption of the carbohydrate

26. Spaghetti
White Bread

27. WFM - follow ANDI and MANDI….
Aggregate Nutrient Density Index…Dr Joe Furhman

28. Tom Jordan’s
30 Second Meal Plan
Breakfast: Protein (1 egg, 2 egg whites, cheese… toast?)
AM Snack: Greek Yogurt
WATER!
Lunch: 3oz Chicken, 1/2c Quinoa, Sliced Green Peppers
PM Snack: 100 calorie pack mixed nuts, apple
WATER!
Dinner: 3-4 oz Salmon, Sweet Potato or Rice, 1c Steamed Broccoli

29. Andy says:
the key to life is the
anti-inflammatory diet!!!

30. ???

31. Empower yourself - Get Help

32. 2
Movement
• Massage
• Exercise
• Chiropractic therapy
• Physical therapy
• Trigger point injections and topical w PT
• Feldenkrais/specialized pt/movement disorder
clinics

33. Benefits to exercise
• Muscle pliability
• Release of endorphine
• Sense of wellbeing/acomplishment
• Social interaction
• or Solitude (removal from technology)
• Indirect breath exercise (yoga)
• Feeling of wake/energy

34. Problems with exercise

35. Exercise Guidelines
• Best form is the one they’ll do
• Establish a routine
• Don’t overdo it! Avoid Push-Crash cycle.
• Expect some set backs
• Take breaks when needed but don’t give up
(1:3 work to rest)
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

36. Starting off
• Warm water exercises
• Tai-Chi
• Pilates
• Yoga
• Bicycle
• Walking
• Body weight and Functional exercises
• Wall push-ups
• Sit to Stand
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

37. Activity for Severe Chronic Fatigue
-FHA EP’s Aimee and Courtney
• Focus on Activities of Daily Living
• Hand Stretches
• Picking up and grasping objects
• Motions needed for getting up, personal
hygiene, getting dressed…
• Breath Exercises
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.

38. Pranayama
• Nodi Shodana
• Ujjayi breath
• Bhastrika (bellows) breath
• 4-7-8 breathing
-5-10 minutes am and pm

39. 3
Mental preparedness-grounding
• Meditation
• Breathwork
• Yoga
• Tai chi
• Spiritual grounding (energy healing)

40. Herb says….
• 10 minutes twice a day = 20 minutes total of
an average 12 hour (720 minutes) day to
improve the way the brain handles the
remainder of the 700 minutes.

41. “Meditators R Built for stress!”
• Yet another task, in the list of tasks, to create
more “space” for tasking………

42. Detaching from structure
• Social media
• Web advertisements
• TV advertisements
• Concept of time constraints
• Care not to disregard goals
• Uof I Landscape and Human Health Lab -“take
a hike!”

43. 3a
Mood Disorder will always “piggy back”
• The “D” word (Depression accelerates!)
• Denial still exists with anything “behavioral”
• Happens to average joes
• Sunday Night Blues
• Q: when is the highest heart attack hour?

44. In your mind, make Sunday-Friday!
• The Sunday night blues have probably existed in some
form since the start of the five-day workweek, which
became institutionalized in the U.S. in 1926, after
Henry Ford began shutting down his automotive
factories on Saturday and Sunday. Now, science is
confirming the phenomenon. In a November, 2009
paper, German and Swedish researchers said surveys of
12,000 individuals confirmed that Sundays are the least
happy day for most people, while Fridays are the
happiest. But a British study reported in The Observer
newspaper found that 26 percent of workers
questioned felt dread and apprehension on the day
they were due to return to work.

45. COUCH TIME

46. How Can Counseling Help? –Katrina LCPC
FHA
• Provide a safe outlet for expression
• Get to the root of what is causing the fatigue
• Offer behavioral techniques to manage
symptoms
• Teach tools for managing/reducing stress
• Provide referrals for integrative care

47. 4
Sleep
• 50-70 million americans = 20%
• 15-25% of children difficulty initiating and
mantaining

48. Sleep “architecture”

49. Stages of sleep
• Stage 1
• Stage 2
• Stage 3
• Stage 4
• REM (rapid eye movement)

50. Dr Ric’s Standard Sleep Protocol
• Reset circadian rhythm –night
• Valerian
• Melatonin long and short
• Lavender or sandalwood essential oil
• Netty pot nasal irrigation
• Comfy clothes
• Journal 3 positive sentences
• Simulated darkness and quiet
• 65-67 degree temp
• 4-7-8 breath exercise

51. Dr Ric’s Standard Wake Protocol
• Reset circadian rhythm –day
• Regimented wake time
• Netty pot nasal irrigation
• Hot water/green tea
• Rhodiola or siberian ginseng
• Lemon, grapefruit, cinnamon essential oil
• Dawn stimulation with light or daylight (with
short 10-20 min bursts later)
• Music/radio talk
• Protein meal/snacks regimented
• 4-7-8 breath exercise

52. 1+4
Naturopathic Solutions – Dr Green FHA
Stress and Adrenal Support:
• Licorice
– Pseudohyperaldosterone and glucocorticoid-like effects
– ↑ access of cortisol to receptors
• Rhodiola
– For individuals who are exhausted, anxious, depressed and
burned out
– Enhance energy production
– Increases physical endurance
• Siberian Ginseng
– Helps body adapt to internal or external stress
– ↑ endurance, concentration, and oxygen delivery to tissues
• Homeopathy

53. TCM
• Whole System Approaches to healing
• Acupuncture
• Chinese herbs
• Tui Na
• Tai Chi

54. To summarize
• Rule out disease
• Replete the depleted
• Behavioral grounding
• Nutritional analysis
• Movement program
• Supplemental care with ND/Homeopathy
• Interrupt/rescue with TCM
Don’t settle for a One Dimensional Approach!!!!

55. One size never fits all…
Make changes that not only work
your heart but come from the
heart….
Starved Rock…..Thanks for Listening!!!

56. Happy Holidays !!!
Next Lecture:
Whole Foods Market Schaumburg
2012 Steps to Sustainable Weight Loss
January 14th
Fatigue Panel Public Forum –
First Health Associates
January 21st
We didn’t invent the practice of medicine….
we’re just changing the way it’s provided.