Integrative Care and the GRATEness of Grand Junction, Colorado; Lumigrate's Bringing it to YOU, WITH You!

"Thank you for inviting me to Grand Junction. There is more promising and inspiring care related to integrated care here than anywhere in the nation."  This was the first of MANY "note-worthy" things Dr Frank de Gruy of Denver's CU Med Center (University of Colorado) said last night. I will share the entire presentation with you in the near future here at Lumigrate because it is my 'responsibility' on many levels, including spiritually, to 'get the word out to to all who are represented in the model. EVERYONE reading this is a medical consumer, represented as YOU; some are also providers during their professional time.  

The concept of providers as consumers -- and hence WHY is change so difficult to make -- was brought up in the question/answer time (where EVERYONE opted to stay 'overtime' and take advantage of the minds in the room, one from four hours away and on the other 'slope' of the Continental Divide and not easily brought back).  Of the 60 (or so) people in the room, I'm so proud to say that FIVE appear in the forums of Lumigrate as content providers! (Liz Kennedy, RN, Cheryl Young, LCSW, Dr April Schulte-Barclay, Dr Paula King, Dr Chris Young). Half of the providers of Lumigrate's video content were there, Dr Paula King and Dr Chris Young; Dr Schulte-Barclay gets an honorable mention as agreed to record but was getting her doctorate at the time in acupuncture and oriental medicine during the time we were recording, as well as running her integrative wellness center and being part of the one I was part of for that first, formative year.

Dr Young and his clinic, co-owned with wife Cheryl (above), Behavioral Health and Wellness, is part of Mesa County's Integrative Care Council, which hosted the event with funds that were the tail end of a large grant ($500,000 was received in 2000 from the Robert Wood Johnson Foundation, for example).  They brilliantly answered the question "What do we do to use this money for the promotion of our Council?" with "bring in a speaker, healthy food, beverages people look forward to at the end of the day and have some FUN!" It was good to see so many familiar faces and NEW faces, one of which belonged to a friendly, outgoing and thankfully good-humored NEW staff member at Behavioral Health who moved here from Minnesota just a week ago, to join us here in our endeavors.  

In years past, I collaborated with the staff and in particular Dr Young, as the OT in the building his clinic "co-located" within in 2004 (Primary Care Partners).  It was at that time I formed my own LLC and contracted with the physical therapy clinic which had also been selected to become part of the 'innovations moving conventional medicine forward". I wish to commend all involved for their continued, long-standing commitment to changing the 'systems' of conventional medicine to embrace integrative care's concepts and change the 'old system' to the new: it's a fascinating process which I believe serves as a model for many to learn from and believe Lumigrate can be one part of that process.  I'm happy to say the CFO of PCP was sitting front and center at the presentation.  

Years before, literally under the PCP roof we were all supporting with our monetary contributions (aka 'rent'), Dr Young and I brainstormed what became 'the You model' five years ago, after being inspired by the first patient with fibromyalgia to have been referred to me by her massage therapist out in the community, who somehow knew where I practiced and that I had fibromyalgia and maybe could help her and not hurt her.  (Sadly, this is the norm with fibromyalgia, the providers can "do better when they know better", to apply the Maya Angelou saying to provider's knowledge.

I'd been tasked with the challenge to respond to that problem by the very first doctor out in the community early in 2004, who I'd approached to market my general OT skills to since he was sending hand therapy patients to the OTR, CHT I shared an office with. That community-based MD was a young, progressive-thinking rheumatologist who clearly valued and promoted his front office and nursing staff to be equal members of the office's team, and they welcomed my suggestion to share a lunch break and discuss what his #1 stated need from me was: an effective program for people with fibromyalgia in our community.  Three years later that first patient came to me via her community MT, and I suggested see one of the PTs in the clinic and also Dr Young upstairs (2 levels, thank goodness for elevators AND stairs for when the power goes out, another story for another day).  

Pretty soon Dr Young, who goes by Chris on Lumigrate's forums, was suggesting we both invest an hour a week of our time (which translates into 2% less $/revenues) and meet about creating an education group in our building related to fibromyalgia.  By summer solstice (June 21), the "Fibromyalgia Forum" had it's first meeting. We all went by first names without having really discussed it; a subtle shift that I noticed occurring as I professionally transitioned into the integrative medicine circles in person or through the Internet. A wonderful analogy shared by Dr Frank de Gruy last night, was the patient being like the quarterback on a football team and the providers are his teammates; it's his lead that is followed and if the patient doesn't take the responsibility of the 'game' (health care) then he won't win the game.  Isn't THAT a paradigm shift, and one that saves huge amounts of money, time and energy ... and lives!

By November/December the people attending (people with fibromyalgia and Dr Young and I), had invited the local providers we agreed upon had been most helpful related to fibromyaliga, many of whom agreed to take the time out of their revenue-making schedules to join us and present about what they 'do'; none came, however, to learn from the others, and without exception they were outstanding presentations. In a time of thin profits, if you're lucky, providers needed to be seeing patients on Thursdays at 4, which was the only time the room was available on-going.  Work schedules, family time demands (people with children), cold weather, darkness and fear of going out after dark or decreased ability to drive in low light, health challenges, etc. were the reasons the consumers weren't coming as often as they wanted.  

I recall sitting in the building's large, high-tech and beautiful conference room recording a seminar on medications for fibromyalgia with a borrowed video camera and thinking  "I wish I had the money to start a website, how hard could it be to put video on a website these days?".  Be careful what you wish for, because if it's something you're intended to do here on Earth, you'll get it!  (And by the way, it's REALLY hard, which translates into expensive when done right, but with nights like last night, I have NO regrets!

Since Dr Young is one of the best 'model makers' I've ever seen, the result of one of those meetings was a hand drawn version of what YOU now see as the YOU model which has been one of the cornerstones of Lumigrate's 'foundation' since it 'went live' on the Internet in March of 2009.  And so I'm sure you won't be surprised to hear, and share my enthusiasm, that Dr Young agreed last night to be the 'keynote' presenter at the FIRST 'open to all' event for the LumiGRATE Groove of the Grand Valley. He and Cheryl Young have a presentation ready to go on Adverse Childhood Experiences (ACE) and the connection to chronic disease in adulthood, and he's previously presented at the annual meeting of the Colorado Osteopathic Association related to ACE and chronic pain.  Cheryl and Chris's original presentation was one of 'The Forums" presentations, done in the evening in the PCP building, that lead to my knowing the next move for me professionally was online to reach more people with innovative concepts.

To 'prime your pumps' for the learning ahead we'll be bringing the Grand Junction live community and the Lumigrate online community worldwide, there is a very clear inverse relationship to ACE score (# of traumas in childhood) to length of life. Also, a relationship of # of traumas to medical costs in adulthood which is dramatic to see in graphical form.  In many other presentations in the room I was at last night, I have seen presentation after presentation on Parkinsons, diabetes, fibromyalgia, and essentially they show the rest of the world's increase in these diseases as pretty much a steady incline and then the US is this EXPONENTIAL CURVE! Why? I believe ACE is one of the answers.  

In my 1996 VA internships I was educated by my psyche-unit OT supervisors and later 'drilled' by a retired Vietnam-era officer on what parts of the brain are altered from traumatic psychological experiences (and thankfully I got 100%/passed!)  That research, done decades ago, asked and answered the question "what determines which veterans of Vietnam ended up with PTSD and which ones didn't", and guess what? The answers were in childhood and the skills taught to them in how to handle stress ... or not.  When you see the ACE questionnaire -- 10 questions, took me one minute to fill out -- it teases out emotional neglect and abuse, physical abuse, sexual abuse, family medical/mental illness, substance abuse (where problem drinking, alcoholic and street drugs are equal offenders and GLARINGLY omits prescription medication abuse).

Having known this since before I passed my board exams to have an 'R' after my name in 1996, and then going out into the job market only to feel I'd gone into the stone age of medicine compared to the VA system, it was with GRATE enthusiasm to finally meet up with someone like-minded professionally in Dr Young, who it turns out also had military experience in his formative career times.  This is what happens when 'the system' is ALL on the same 'team'; in insurance-based medicine we are not 'rewarded' to talk to each other and collaborate about a patient (you cannot charge for your documentation time for other providers to read, and you're not allowed to charge for time you talk in person or on the phone (or otherwise) to a teammate, another provider.  This is the biggest single downfall of the system of medicine the US is currently have take us under financially, and with it, all the good people on the boat.  The plans for future 'medical homes for primary care' will allow reimbursement for the physicians and their assistants to phone and email patients and it provides much hope. This is per an expert from San Francisco who was brought in for a similar presentation a year and a half ago, which I have covered here at Lumigrate -- look around in blogs from May of 2010, you'll find it. 

Last night, Dr de Gruy followed four other experts who opened the evening presentation at St Mary's Saccamono Research Center's seminar area consumers/patients/clients speaking on behalf of how integrated care from four different 'systems' in Grand Junction had changed THEIR health and lives for the better.  The first of which, with my and Lumigrate's history I've shared above, was SO a "RIGHT ON" moment -  "I'm already glad I came" and indicative of the understanding of the people who put on the event.  Helped to the podium was a gentleman wearing dark classes and a hat which I've come to recognize from a distance to be one of a Veteran who is wanting all to know and be reminded of the service given in the military. Men's hats in general speak volumes about who they are want they want people to know about them; veterans are not exception to having their own culture and symbols which 'speak a thousand words'. The more adornment, the deeper the story. His hat spoke volumes, and his five minutes of words, as those of the following three expert/consumers poignantly set the tone for 'why are we here tonight'. All were a bit nervous, all had their emotions 'sitting in their voices', I detected, and they all were marvelous.

An hour and a half later, I came away having shared the evening with over 50 providers and support / administrative professionals, with a sense that there ARE solutions "at hand" for the ongoing and deepening health care crisis in America, and it's truly a matter of, it is simply a matter of getting those in power to know of them and support them.  And the key, as Dr de Gruy stated, is for the people/consumers who have benefitted from integrated care to let their politicians hear/read from them.  

We're clearly in the 2012 election 'zone' now, and so I encourage everyone to consider really making this a priority.  Become more 'active' than ever before in their end of the political process.  Many over the past centuries have fought for the rights we have to vote, to live in a 'free' and 'democratic' society.  We have much to be thankful for.  Today we have more at stake than any time since World War II, which was an intensive time of struggle but which lasted under five years and went on to spur the economy in the US to heights I will fondly remember from my formative years in childhood in the 1960s and early 70s.  Think about how that compares to the "battles" we are in today, and I believe we collectively are only seing the part of the iceberg above the water. 

For me, that was the #1 take home point of the night's presentation from Dr DeGruy because Lumigrate is designed to be 'for the people who have the most interest in health care (the consumers/public) ..... to then take to their providers and ask for their assistance in teaming with them related to the information they've found at Lumigrate (you'll see Print and email features at the bottom of all areas in the forums and blog), OR use the providers on Lumigrate if they are accessible to them and many are serving nation-wide patients/consumers/clients through technologies of telephone, visual conferencing, etc).  

I reflected during the presentation several times on Lumigrate's complementary regimen of videos that have information on the things being discussed: the honorable veteran spoke of "mindfulness meditation" being the most impressive thing he's experienced recently for his health (covered by Dr. Paula King's video "Strategies for Lasting Change", $0/free on Lumigrate and with us since day 1/launch), and most recently in the Forums via Deirdre Rawlings, ND, PhD (holistic nutrition) in "Yoga Nidra with Deirdre" (see Forums, Chronic Pain/Illness section, Deirdre Rawlings forum). After the presentation, Dr Chris Young approached me and remarked about his video on Lumigrate's similar content to Dr De Gruy's (see videos tab, titled "Health Management: Models and Paradigms for Change" which he thought was only recorded TWO years ago, but it was three and based on presentations we'd done in the Fibromyalgia Forum that last half of 2007.  Time flies when you're having FUN!)  

Dr de Gruy closed by saying that what it is going to take is more people doing what we were doing last night: giving up our nights and weekends for this cause.  I wholeheartedly agree and anyone who has talked with me to any extent whether a provider on Lumigrate or otherwise a friend, knows that I have said emphatically for the last year or two: We are going to have to apply ourselves with more seriousness than we ever have. And the providers you see the most of on Lumigrate's forums are doing just that! We are working HARDER than we ever have before, because the stakes are so high.  We care about health care and people so much and we have matured to recognize the needs and relish the comaradarie.  I was working until after midnight and still getting emails from providers on the West Coast when I went to bed at 1 am. 

One last important thought today about 'effort': Dr de Gruy appears to be about sixty years old and clearly was raised in the south, and he spoke of being a career MD, having been a primary care physician, researcher and now teacher/speaker.  He spoke of learning from his daddy to "leaning into problems with your shoulder" and to not waste your time on people who are not asking for you opinion; I agree, on both accounts. The beauty of Lumigrate is that people who aren't up to putting their shoulder into something can exit and not come back if they chose so we only have those here who are putting forth the effort to learn or educate/share. Not all have to be 'putting their shoulder into it', however; in my opinion, YOU might be reading this and be effective in the cause by committing yourself to actively meditating toward the outcomes we're commonly in favor of here, and in that regard, your shoulder is really your mind.  

No matter how YOU go about making change, I call upon you to do so.  And come back here, we'll continue talking about it.  As Yenta says in our Forums "It Can't Hurt"!

(Yenta, the 'connector' in a community, has a forum in our Forums area titled "It Can't Hurt" - she's our wise humorist for almost two years now, provided by a wise woman who works in the retail industry part time due to partial disability, and like the veteran, above, is an expert about health care through her own challenges and learning.  Integrative medicine/integrated care recognizes the patient as the key in health care.  Thank you to all the consumers and providers who embrace and utilize Lumigrate in whatever form ('using' only, providing content, referring others) for themselves or their patients/clients/consumers.  Lumigrate has been touching thousands of lives and expanding the knowledge about integrative care for almost 2-1/2 years on the Internet, another year locally prior to that. It's a journey worth every weekend and evening I've given up because of YOU.  I truly HOPE you feel the same about your time here today and any day) ~~ Mardy