On Time and Life and Goodness

January 25th, 2015 by Nick Jacobs No comments »


One uncomfortable truth about getting older is that it sometimes feels wrong and even intellectually wasteful to me. As our brains fill with more and more useful and exciting information and our ability to problem solve grows exponentially while our lists of contacts and areas of influence expand, we begin to realize that there’s plenty of time, but often ask, “Is there enough life?”

Leonardo Da Vinci said, “Time stays long enough for those who use it.”

My goal, instead of watching life passing by, has been to enthusiastically work on creating a legacy that helps others? I’m not striving for Sainthood or even historical immortality through these actions, it just seems so much more productive than the alternative.

As we begin to notice the sands in your own personal hour glass rushing through like meteorites in fictional hyperspace, we realize that the panic or unrest that we sometimes experience is not so much fear of death, but fear of not having the purposeful time left on this planet to get done whatever we think we were put here to do. At least that’s been my challenge.

For those who think that this existence might all be random or arbitrary, that burden can be unbearable. The envy that this consideration makes many people feel toward their religious friends can be almost immeasurable. Yet, understanding those who reject evolution becomes easier because we can see that those individuals can’t bear to think that this all might be accidental. It is impossible for many to wrap their consciousness around infinity within nothingness.

If they are to embrace the knowledge that man and all of life simply evolved through billions of years of complex reactions and chemical interactions, there has to be some safety net, some handle to grasp onto tightly or they might free fall through infinite intellectual space.

To simply believe that all of this is just an explainable result of that evolution, like a tree or a butterfly that is here until it’s not here, then meaning has to be derived or created from some other source, some other means.

Obviously, it would be much easier to go through this fleeting journey with no guiding principles, no moral compass, and no ethical boundaries because every day could be a random holiday of self-gratification without retribution. On the other hand, the emptiness of that narcissistic journey is well documented.

We now know, definitively, that we are connected at a molecular level with everything and everyone in the universe.

So, back to time.

If we think positively, we can feel peace in this quote by Rabindranath Tagore, “The butterfly counts not months but moments, and has time enough.’

I once had a philosophy professor say that actually finding God was like looking for a black cat with its eyes closed in a dark room. Religion, of course is the most popular way of dealing with this challenge of balancing infinity and mortality, but maybe there are other ways as well; like goodness.

Possibly, just embracing goodness can be a great answer, a wonderful handle upon which to grasp.

Think about the ethical implications of The Golden Rule. It exists in some form in every religion of the world. Maybe just doing the right thing can be enough.

If we acknowledge our complex web of connectivity, why not spend each day being good to others, and thus being good to ourselves?

It shouldn’t be about guilt. It should be about making clear, positive choices between things like giving vs. greed or loving vs. hating; kindness vs. meanness; positive actions vs. negativity. Those values represents something good.

What if we’re born, we live, and we die and that’s it?

Deriving meaning from that experience, and facing our own mortality though that reality can be an overwhelming challenge.

I say, “Regardless of our personal beliefs, simply embrace goodness. You can’t go wrong.”


Everybody Has a Story

October 8th, 2014 by Nick Jacobs No comments »

Everybody has a story.  This morning I stopped in two coffee shops over a three hour period, one for caffeine and one to give back the coffee I had consumed at the first shop; read-bathroom break.  Regardless, in both places, the idle conversation of the patrons caught my attention as one described a mystical, medical anomaly that her son had experienced, and then a young, healthy looking man had a brief discussion about his leukemia treatments.  There was a table filled with 60-something women who were discussing challenges that they were experiencing, and three other guys in the corner were lamenting their difficult jobs.

The conversations weren’t all medical, but they certainly were living-related, and it reminded me of a motivational speaker that I had heard several years ago who described the two sides of The Great Barrier Reef.  The side that was pummeled daily by the ocean.  He explained that that was where all the living things were thriving, and the other side which was calm, the Bayside, had no life.    It takes the stress of life to give us life.

Just the day before, one of my friends and former employees was discussing his absolute complete fear of retirement, and I can certainly relate to that because I have no interest in sitting idly by watching the sunset every time until the very last time.

The night before that I was seated randomly at a table with a grandmotherly looking, white haired woman who looked to be in her very late sixties or early seventies.  After a glass or two of red wine, I boldly asked her about her background.  At that point she said in a very soft spoken voice that she was a government bureaucrat.

Quite frankly, when she described the agency for which she worked, I had visualized that it was filled with older ladies who looked like her, but wore red high top tennis shoes and couldn’t for the life of them do anything but check off boxes positively or negatively as they approved or disapproved of various applications.  As I forcefully delved inquisitively into her life, my eyes and ears were opened to someone with a real story.

This little old grandmother had been a nurse, but she didn’t stop there.  She went to graduate school and then volunteered to serve for three years during the Vietnam war assisting with the locals.  Of course she was able to speak the language and still does as she seeks out the wonderful Vietnamese restaurants in The District of Columbia.

When she came back to the States, she went to Johns Hopkins University where she got her PhD, and she has been involved with public health ever since that time.   This lady was hardly the red, high-topped tennis shoed clerk that I had anticipated.  She had an amazing, giving background that was indicative of many of the bureaucrats that I’ve met over the years; super smart public servants who want to make their country a better place.

Bottom line, though, everybody has a story.

A friend of mine wrote a speech for me once called Bubblewrap.  The primary content of the speech was that we should look at people as precious things often covered in protective, cushioned bubble wrap, and until they are taken carefully out of their bubble wrap, we really have no idea what their story is.  We really don’t know what their contribution has been to society, what their talent is, what their motivations are, what they love, what makes them tick, or what has hurt them.  It’s one of those, don’t judge a book lines, but more importantly, it’s a everybody brings something to the table things.

We all have a story.   I’m sure you do, too.




An Amazing Idea . . .

September 25th, 2014 by Nick Jacobs 5 comments »

No one can escape it, aging that is, unless of course we come smack up against its alternative.  We want to have some fun, enjoy ourselves, live a little, but if we wait too long, we often times miss the zone.  The zone is when we have enough energy, good health and flexibility, to still dance and have fun and not suffer from borderline feebleness.  Unfortunately, that oftentimes is exactly what happens when we are strapped financially.

Some wise person once said that life is backwards.  We live our early adulthood with limited or stressed incomes due to babies, houses, education loans and the like.  Then, when we finally are just a little bit comfortable financially, we are often faced with the realities of the aging process.  Well, I’m happy to report that there is a remedy to this problem that works so well it is almost incomprehensible. It’s called living as a family.

When I first observed this phenomena, I was flabbergasted and stunned by how well it worked.  Having said that, I’m sure there must be some very real drawbacks, but generally, it appeared to be an incredibly effective way to live.

My introduction to this concept was during my recent trip to the little town in Italy where my grandparents were born.  My great Uncle Marco had built a modest house on the Main Street upon which additional stories were added as successive generations were born.  In this three story house lives a mom, a dad, and two children and their families.  They have a three car garage with additional parking spaces in the driveway and many nights they share the evening meal.  They all have their own space and yet, they share a roof. What a concept.

When I thought of my own family it hit me that we had done the same thing as kids.  We lived with my grandparents in our own space, and that form of modest living allowed my brother and I to get college educations with little or no debt to pay off afterwards.   Of course, if you raise your kids in a rural area and they want the stimulation of an urban area or vice versa that changes the equation considerably.  The other wild card would be if they married awful people; the stress generated from those decisions can devastating and painful.

But the families that I observed seemed to have balanced their freedom, independence, and love very well, and by pulling their resources in the form of NO MORTGAGES, occasional built in grandparent babysitting, and shared second vehicles, their financial needs were incredibly less.   In fact, it seemed like they could do things like pursue their dreams without fear of homelessness or being ostracized.

One of my cousins was a professional musician who also delivered bread from his cousin’s incredibly successful bakery. Another had just completed a bed and breakfast in what had been one of their garages and on the adjoining land they had created a petting zoo. Everyone had a big garden, jarred and canned fresh fruits and vegetables and made their own wine.  Still one other cousin had fenced in the acreage for an ostrich farm and another was harvesting olives for olive oil.  They didn’t appear to have much discretionary money, but no one suffered because they had plenty of pooled resources.

Of course they all went to church and danced at the church festivals, and they all spent at least some time together over shared meals. It seemed simple, beautiful, amazingly supportive and loving.        What would life be like with a scenario like this in America, relationships where the family elders could share their wisdom through potentiation sessions with grandchildren; where recipes could be learned and passed on from generation to generation and love would be at the center of everything?

The scenery was amazing, the ancient ness was overwhelming, but family was everything.


Become Certified in Integrative Health!

September 4th, 2014 by Nick Jacobs 1 comment »

Academy of Integrative Health & Medicine (AIHM) Offers First Course & Certification in Integrative Health for Executives

DULUTH, Minn.–(BUSINESS WIRE)–The Academy of Integrative Health & Medicine (AIHM), the organization that created the de facto standard in certification in integrative medicine for healthcare practitioners to assure exemplary holistic care, announced it will offer its first course and certification in Integrative Health Administration. The new course and certification program entitled, Certification in Integrative Health Administration (CIHA) will be held as a post-conference October 30 and 31 as part of the AIHM annual conference: Science and Connection: A New Era of Integrative Health and Medicine in San Diego. It is designed for healthcare executives including CEOs, CFOs, CMOs, clinicians, and professionals in marketing, strategic planning, nurse management, as well as supervisors and directors. Enrollment is limited to 150 in 2014.

“Bringing Integrative Medicine to Your Practice and Health Care System.”

The course includes two days of onsite activities followed by six hours of online learning entitled, “Bringing Integrative Medicine to Your Practice and Health Care System.” The online learning portion includes nine modules. Each module is followed by a brief online post-test; each must be completed by December 15th, 2014. Participants must achieve a score of 80 percent on each post-test to earn certification.

The program leader is F. Nicholas (Nick) Jacobs, FACHE, a ground breaking national consultant in implementation of comprehensive integrative care programs in major healthcare systems. Jacobs is the author of two books on integrative care. His work has attracted the attention of the national media including The Wall Street Journal, Forbes, Fortune, USA Today, Becker’s Hospital News, and professional journals and websites. Jacobs is a partner at SunStone Management Resources, VxVentures and LifeSEQ, LLC.

According to Jacobs, “Delivery of excellent integrative healthcare is not enough. Intelligent patient care must be accompanied by business acumen to assure economic survival. We are finally moving toward health care that is outcome based. Outcomes in healthcare are a two-sided coin: the health of the patient on one side, and the economic health of the medical institution on the other.”

Participants in the certification program will gain deeper knowledge about evidence based integrative medicine approaches. Utilization of these modalities assist in diagnosing the underlying causes of health conditions, and can drive down the cost of healthcare. This knowledge is becoming a key ingredient to economic survival.

In addition to Jacobs, other luminaries in integrative medicine will teach the course, including Mimi Guarneri, MD, FACC, ABIHM, Jeffrey Bland, PhD, FACN, FACB, Mark Tager, MD, and Robin Guenther, FAIA, LEED AP. The program includes an exclusive tour and private reception at Dr. Guarneri’s state-of-the-art integrative center, Pacific Pearl in La Jolla.

The certification fee is $1500 including tuition, course materials, online content plus associated post-tests, certificate, breakfast and lunch both days, and the aforementioned tour and reception at Pacific Pearl. Participants who are also attending the main conference will receive a $600 discount off the CIHA fee. A discounted group rate of $1200 per person is also available. Please call Scripps directly to register a group at 858-652-5400.


The Academy of Integrative Health & Medicine (AIHM) is an international, interdisciplinary, member-centric organization that educates and certifies healthcare professionals to assure exemplary holistic care. The AIHM’s training incorporates evidence-based research, emphasizes person-centered care, and embraces all global healing traditions. www.abihm.org/aihm



Academy of Integrative Health & Medicine
Seth Romanoff, 218-525-5651 x 1002



Preparation for Life!

August 26th, 2014 by Nick Jacobs 4 comments »

It all started at the age of eight with my paper route. Each day the three paperboys from our little town, Howdy, Roy and I would sit in front of my aunt’s grocery store chewing double bubble bubble gum, or dipping a one cent pretzel rod in a ten cent Coke while we waited for two trucks to drop off our papers.  One contained the Connellsville Daily Courier, the other had The Uniontown Evening Standard and the Pittsburgh Press.  The trucks drove by like NASCAR racers and the tightly wrapped bundles of papers would come flying out of the back and hit somewhere in the muddy front of Aunt Mildred’s property. Usually the Uniontown and Pittsburgh papers arrived early.

I’d count the papers carefully to make sure that they hadn’t short- changed me.  If they did, my parents would have to sacrifice their paper for one of my other customers.  Then, I’d count them again (until my fingers were black from the ink),  to see if they gave me any extra papers that I could try to sell.   That didn’t happen often, but when it did, I could make some extra money and recruit new customers.

My take home pay was $.015 (one and a half cents) for the Pittsburgh Press and $.02 (two cents) for the Uniontown paper.   My total profit was about $1.00 a day and $2.50 on Sundays.  On Sundays I’d deliver 50 papers from a red metal wagon with white metal sides.   Sections of the Sunday papers came on different days, and, on Sunday morning we’d put them together into one big fat newspaper. Eight dollars and fifty cents a week was ENORMOUS MONEY for a kid in the late 50’s and early 60’s.

Eight dollars and fifty cents in 1950’s money is worth about $70 now.  Think of it.  Seventy dollars a week in spending money! Heck, I could buy shoes, a shirt, socks, and dress pants for about two weeks’ worth of work. I spent most of my money on clothes.  My second addiction, however, was building plastic models of airplanes, rocket ships, boats, and cars.  My room was filled with models.

I really liked most of my customers. Generally, they were sweet people.  Of course some weren’t.  At least six of my customers tried to stiff me every week. They would hide when I came to collect the 42 cents that they owed me.  It was great practice for my future, losses from accounts receivable. It used to take me one and a half hours to deliver about 45 papers every day. Because of my paper route and my love of music,  I developed the discipline to live on a schedule.  I used to deliver those papers, go home and practice my drums or trumpet, take a nap, do homework, eat dinner, practice more, and then stay up to watch the Johnny Carson, alone every night.

Sometimes life on my paper route was cluttered with complications, challenging personalities, and, every type of weather, ferocious dogs, slippery sidewalks, and the occasional town bully.  But all of this was like an amazing internship for what would become my adult life.  As I went from playing drums to trumpet, to becoming a band director, to arts center director, to tourism president, to hospital administrator, to founder of a research institute, and now to entrepreneur, those days of my youth have served me well.

I still buy my own clothes, interact with the good and the bad personalities, the rip-off artists, and the kind, loving, gentle people who only want to make life better. Because of my paper route, I understand that I was given an amazing opportunity to learn, to grow and to get a head start on adulthood.    Some days, as I watch my grandchildren on their I’s (I Phones, I Pads, I Touches, I Pods), I just feel a little sad that they don’t deliver newspapers.


BMW . . . ing

August 20th, 2014 by Nick Jacobs No comments »


If you don’t know what that abbreviation stands for, Google it!  I’m not referring to: BMW: Born Moderately Wealthy, BMW: Brought My Wife, or BMW, Bring More Worries.  In fact, I’m not thinking about anything that is directly related to a thing, okay, well, maybe I am.     

What I’m referring to is the phrase, Bi*ch, Moan, and Whine!   For whatever reason, I’ve recently been inundated with individuals who are not happy about various things impacting their lives.  I’ve been hearing about money, jobs, marriages, fees for cable TV, healthcare and college costs, the government, animal cruelty, gasoline prices, racism, city manager selections, and a dozen or so other issues.  In fact, even though Heinz just had to pull their tainted baby food off the shelves in China (Now, that’s a reversal of fortune, Mr. Buffet).  The only thing that I haven’t heard people complaining about (euphemism for bi*ching) is the “price of rice in China.”   

Ha, bet that rang a bell for you ole folks.  What ever happened to that phrase?  We used to say that all the time in the 50’s and 60’s?  When someone was babbling on about something that we thought was meaningless in our lives, we used to say, “Now what’s that have to do with the price of rice in China?” 

Guess it’s not so meaningless anymore? (If you’re interested, you can look up the “Live Rice Index” for the price of rice in China), but I digress. My philosophy has always been, if you can do something about it, then do it.  If you can’t . . . then move on, my friend.   Truthfully, in this country, we hold the power to change nearly everything, but we choose instead to join the BMW Club.  

Think about it.  We have in our hands the amazing ability to influence and to change almost anything that exists.  It’s a simple formula.  We ban together and say that famous line from the movie, Network, “I’m mad as hell, and I’m not going to take it anymore.”  

Could you imagine showing up en masse anywhere and yelling that?  It would be international news.  If we could get enough people to come together to offer alternative solutions to almost any problem that we face, the offenders, enforcers, and especially the elected law makers would be forced to pay attention, and public pressure could change everything.  

The key to this tactic is to find enough people who care about ANYTHING.  

We’ve all seen what Rosa Parks, The First Lady of Civil Rights, The Tianamen Square tank man, Gandhi, Mother Teresa, Martin Luther King, and now Pope Francis, the former night club bouncer, have done to contribute to CHANGE in our world, but we . . . you, me and tens of thousands of our closest friends, can really make a difference. 

Heck, thousands of us just threw cold water on our heads to make a statement about ALS, and before that . . . ?  Probably a lot of the participants thought ALS stood for Advanced Life Support or Apply for Disability! 

What’s the quote from Margaret Mead? “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”  (She also said, “Children must be taught how to think, not what to think,” but that’s a different column for a different day.)  

The whole idea here is to get us together, to unit, to make change!  What would you change if you could?  Want lower gas prices?  We could do that.  Want to stop dangerous, unmarked oil trains from driving through our towns and cities.  We could do that. How about big corporations not paying taxes? 

The key is to stop the BMW-ing, and get your friends together and present positive ideas to the folks who can make the changes.  It’s an American right.  

Oh, and you might want vote this year, too! 


Smokin’ and EATIN’

August 4th, 2014 by Nick Jacobs No comments »

If you’ve ever seen the television series, Mad Men, you can begin to get the flavor of the environment back in the 60’s. Cigarettes were so glamorized that we literally lived in a haze of blue smoke. Movie theaters, restaurants, hospitals and the schools had areas where the employees smoked all the time. 

One of the most offensive photographs I had ever seen that depicted the acceptance of smoking most vividly at that time was a picture of a female neonatal physician holding an extremely tiny premature baby in one hand and her smoking cigarette in the other.

It was interesting to me that smoking had been seen as detrimental to health beginning in the late 50’s and early 60’s, but all of my relatives kept on smoking. My Dad, Uncle Bill and Aunt Mildred all fell victims to tobacco in their late fifties or early sixties, but the carnage continued and still continues today.

When Big Tobacco got science involved, we began to see chemicals and additives that made us addicted. In fact, one study showed that quitting cigarettes was more challenging than stopping heroin.

The real irony is that we all know the horrible side effects of smoking cigarettes, yet more than 20% of us still smoke in the United States, and nearly 30% of Europeans still smoke. 1.1 billion people are still smoking internationally.

Now, however, we are seeing that the lessons learned from marketing, countering scientific evidence, and adding addictive ingredients and cancer causing substances has been passed over to our food industry.

We’re predictably acting in exactly the same way. We’re ignoring the facts and ignoring our brains and consuming manufactured foods that are as bad for us as those enhanced cigarettes, and we’re doing it by the billions worldwide.

After deep consideration and much consultation on this matter, I’ve decided that it’s not the lack of education that’s the problem. It’s not the lack of intelligence. It’s not even the lack of exposure to the truth that is causing this. I truly believe that we, as a species, are Meatheads!

One of my bosses used to describe people like this, “They get up in the morning and go through the motions; go to the bathroom, brush their teeth, shower, grab coffee, go to work. No thinking. When they get to work, they open their skulls, remove their brains, and place them on a hook until the end of the work day.”


What’s it gonna take to get us to wake up and smell the chemicals? Seriously, there are hundreds, even thousands of untested additives being placed in our manufactured food, and we just go on eating it like sheep being led to, well, to hospitals. Most of the work that we did in cancer research was related to genetics, but 75+% of the cancers that we saw were related to the environment.

Why is it okay for industries to purposely poison us and produce marketing campaigns to entice us to consume the poisons that they are putting into our foods? People went crazy when the unregulated Chinese doggie treats killed their pets, but everyone keeps eating our make-believe foods.

In California they must post this sign on the windows of certain fast food restaurants: Warning “Chemicals Known in the State of California to cause cancer, or birth defects, or other reproductive harm may be present in food or beverages sold or served here.”


As the World Congress on Cardiology, I observed 70% of the physicians in the room smoking. One physician stood in front of a Power Point presentation with a cigarette in his left hand as he pointed to Moscow, Kiev and Belgrade. He exclaimed, “Number one in heart attacks, Moscow. Number two, Kiev, and number three in heart attacks, Belgrade.” Then he took a long drag on his cigarettes and said, “What’s wrong with this picture?”



I’m about an hour away from my son driving me to the hospital. 

July 25th, 2014 by Nick Jacobs 1 comment »

The interesting thing about time is that it can go by in a wink, like life, or it can drag on like some form of ancient water torture, one drop at a time.  I’ve decided to spend this time with you.  Some of you may know that I’ve had a few weeks to think about my life.  Two and a half weeks ago, I experienced some discomfort in my chest that was NOT normal.  The problem with chest discomfort is that, sometimes it’s just that.  Unfortunately, heart symptoms and digestive indicators can mask each other.  So, I joke a lot about the magic question,  ”Will I burp, or will I die?”  This time, however, with three previous CATH experiences, I knew that the latter one was more likely than the former.  After trying one day of home remedies, I acquiesced to the “adult DVD” inside my brain, and went in for a check-up.   All the while I was hoping that my instincts were misguided, but knew deep down that they were not.  In fact, when the cardiologist recommended a CATH, it was like the proverbial Déjà vu all over again.

The drill is well known to me, but the outcomes never are.

This time, nine years after my previous CATH, I utilized something that was not part of my earlier support network, FACEBOOK.   For those of us who mainline connectivity, social networking can be a very powerful and meaningful thing.  In fact, I used to speak all over the United States about blogging, texting, and You Tube long before Facebook was in vogue.   Well, of my designated FRIENDS on Facebook, over 200 took the time to respond to my announcement of impending medical attention.  The result was an unbelievable level of love that poured out in these comments from my FRIENDS.

Today, I truly do feel surrounded and bathed in love, and it’s a very interesting cascade of love, because it’s crosses six decades of my life.  I’ve been touched by childhood friends, high school and college friends, associates, former students, and former employees and co-workers from almost every job I’ve ever held.  I’ve been touched by good wishes and warm thoughts from all over the globe.

This will be a good day no matter what the outcome because I leave here confirming that there are far more good hearted and caring people in this world than there are destructive ones, and I do believe that we will eventually prevail.

As I look out of my office window today, I see a sky that is so blue, so perfect and reminiscent of why I have loved living in this State, in this country, on this planet.   I take a deep breath and remember today’s blue sky, tepid weather, and amazing ever changing seasons, and I appreciate my life on all levels; the students that I’ve nurtured, the amazing  jobs that I’ve been privileged to have had, and most of all,  the beautiful, caring, family that has given me love, light and hope for the past 40 plus years.

One healer reminded me to embrace today the memory of the touch from the little hands of my grandchildren; another reminded me of how I vaccinated his soul with positive energy as a young student.  Regardless of the sentiment, it’s been so fulfilling that all of those people are holding me in their hearts just like I’ve held them in mine all of these years.

My mother’s favorite saying was from John Wesley, ““Do all the good you can. By all the means you can. In all the ways you can. In all the places you can. At all the times you can. To all the people you can. As long as ever you can.”

I’ve embraced those words, and know that many of you do as well.  Hold onto love. It’s the source of our energy and strength.


ICD10 – Struck by a DUCK!

July 20th, 2014 by Nick Jacobs 2 comments »

For several years something called ICD-9s dominated the healthcare providers’ reimbursement landscape.  It’s how they get paid for treating their patients.  There were 13,000 different categories of ICD-9s that were always up for individual interpretation.   Well, as only they can do, the federal government has simplified the decision-making process by complicating things exponentially.  Now, instead of the traditional 13,000 choices, there will be something called ICD-10s with 68,000 billing codes.  Over five times more obscure, yet descriptive, billing selections for the already confused healthcare workers to decipher.

The implementation of these expansive diagnostic code changes will take place in October, 2015.  Katie Bo Williams of Healthcare DIVE News wrote a wonderful description of the  most absurd codes that will be a part of the ICD-10 list, and some of them were stupid enough to have some fun with here.

A few years ago, when the codes were beginning to appear in writing for the first time, I was working in Florida and was having lunch with a group of very Southern individuals.  I jokingly said, “You know there will be a billing code for getting hurt while riding on the back of a hog.”  One woman looked almost indigently at me and said, “You’re obviously not from the South.  Our hog races are very important to us.” To this day, I’ve never seen hog jockeys!  (Bucket list.)

W55.41XA:  Bitten by a pig, initial encounter.    Let me be perfectly clear.  This code absolutely is referring to a farm-related injury.   Because my farming experience has been pretty much limited to geese who bite and cows with limited denture capabilities for significant biting, I can’t personally respond as to how risky pigs can be if aggravated.  I think it’s interesting, however, that I already have two pig references and we still have several hundred more words to go.  Does this imply that, not unlike our schools, airports, and other public buildings, we’re going to have to have armed guards to protect us in our pig pens?

One of the fantastic code descriptions that Katie writes about is V9733XD:  Sucked into a jet engine, subsequent encounter.    It took a minute for this one to sink in because I read it as, “If you happened to have been sucked into a jet engine and lived and then were sucked in again, there was now a code for it.”  In the vernacular of the times, that would really suck.  She went on to explain, however, that it meant subsequent encounter with a physician, not a jet engine.

Z63.1: Problems in relationship with in-laws.   Truthfully, I can’t believe they didn’t have this one in the first 13,000 codes.  If you’re a fan of “Sons of Anarchy” it’s certainly clear why this needs to be a code.  Who hasn’t had this challenge?

Two or three years ago, one of my doctor buddies used this next one in a speech he was giving regarding reimbursements and what was coming our way.  Y93.D: V91.07XD:   Burn due to water-skis on fire, subsequent encounter.  A person has to ask, “What could you possibly have done to even get your water skis to catch on fire?  Did you soak them in a flammable liquid for two days?  Did you jump through a burning hoop on skis?”  In that case there should be a code for flaming Speedos.

12.Z99.89: Dependence on enabling machines and devices, not elsewhere classified.   This one obviously refers to a physician having to counsel us because of our addictions to electronic communication devices.   As Katie says, “There’s just no substitute for a Crackberry.”

Finally, my very favorite one is W61.62XD: Struck by a duck, subsequent encounter.    It’s my favorite for reasons that I can’t really write about here relating to a really old joke, but it is one of the only codes that rhymes.  He was struck by a duck!   Get him to the ER. STAT!




It’s NOT Business; It’s Personal

March 31st, 2014 by Nick Jacobs 4 comments »

Next Gen Sequencing, Pharmacogenomics, the Microbiome, and Integrative Medicine are leading us quickly into the next generation of personalized medicine where you will be treated individually based upon your specific genetic profile.  No more guessing; no more accidental dosages; no more unnecessary tests; the next generation of medical treatment is here, and it’s up to you to find the precise doctors and health systems to treat you appropriately.  Oh, yes, and Integrative Medicine gives you the tools to become the master of your own destiny by influencing your Epigenetics.  (Those genetic modifications which are influenced by personal health related decisions that do not change the DNA.)

Did you know that the Amish carry the “genetic indicators for obesity,” but they sure aren’t fat?  How can that be?  Well, if you walked an average of 20,000 steps per day, you would potentially alter your epigenetic profile as well.  Dr. Dean Ornish started working on this idea back in the late seventies with a revolutionary approach to health.  In fact, it was so revolutionary that the FDA literally questioned every aspect of his concept on many levels.  His aggressive, controversial approach to healthcare was a combination of diet, exercise, stress management and group support.  Can you imagine anything so contentious?

The truly amazing lesson learned from his work initially was that cardiac victims were able to regain their health and take control of those multiple morbidities that were leading them toward a premature grave.  As an early adaptor of the Ornish Program, we saw amazing transformational outcomes with our participants that were here-to-fore unexplainable.     Angina pain virtually disappeared a few weeks after starting the program.  Leg cramps went away.  The average person lost over 20 pounds but was a virtual eating machine, and people suffering from things like impotence, inflammatory disease, i.e., auto-immune diseases and general depression oftentimes experienced remission on some level.  Truthfully, the most fascinating outcome from this program was that those individuals who entered it saw a significantly improved psychological profile that remained positive long after completion of the actual hands on portion of the work.  They literally got their lives back.

By focusing on specific genetic panels, next generation genetic sequencing will help individuals pinpoint not only current, but also future problems nestled away in their DNA, and, like the Amish, through Integrative Medicine practices where we are literally treating the root causes of many of these afflictions, physicians and healthcare providers will not only be able to help you control these risk factors, in some cases, they could literally help to ameliorate the risks indicated in your genetic map.

Now, imagine having 300 of your genes tested to determine what medicines you can metabolize, and as a result of that test never getting the wrong medicine prescribed to you again.  It’s a onetime test with a life time of results.  If a certain number of human beings are destined to have a negative reaction to specific medicines, those medicines won’t be prescribed because the Pharmacogenomic tests will counter indicate its use.  The entire concept of trial and error medicine or “only one in one hundred thousand” risk factor exposures will eventually be virtually eliminated through Pharmacogenomics.    Have you heard the radio spots for Vanderbilt University Medical Center that claim protection from incorrect heart medications, or The Cancer Treatment Centers of America’s advertisements for genetic testing?

Finally, what about the microbiome?  We can finally analyze the millions of living organisms in our body’s’ digestive systems to determine their benefit or potential negative impact.  Only 1% of these organisms are harmful to us, but the other several million are literally believed to be contributing to everything from leaky gut syndrome to curing C-dif colitis.

So, let’s review: Integrative medicine, NextGen sequencing, Pharmacogenomics, the Microbiome and YOU?   Personalized medicine is knocking on our door on multiple levels.  Now it’s up to us to find the right practitioners, the well-schooled, open minded, and progressive medical centers that can combine these various approaches to keep us healthy.