Monday, November 4, 2013

Following My Passions: Healing & Teaching

Getting Personal With Medicine

As you know, one of the aims of the second half of my career is making medicine available and understandable to everyone. That is the reason I wrote How To Think Like a Doctor and Como Pensar Como un Doctor and the reason I am here in Nicaragua teaching medicine to providers at all levels of experience. It is also one of the reasons why I write this blog.
One problem with modern (Western) medicine is that we physicians tend to treat individuals as groups of people. Medications are tested on large populations; they are approved for mass consumption; and side-effects are noted for "common" reactions. Not all medical traditions treat people like this. Chinese and Indian  medicine (Aruvedic) for example take an individualized approach to health care: what works best for YOU?
We used to say that Rheumatology was the discipline of treating the untreatable. Which means people were were dosed with medications that caused HUGE problems like corticosteroids and non-steroidal anti-inflammatory drugs (NSAID's). Don't get me wrong: I love Western medicine and I'm impressed with modern medical technologies. What I don't like is the shotgun, or in the case of the U.S., cannonball approach to therapy. And secondarily, I don't like being told by mainstream physicians and the government that that is the only way to treat people.
That is now going to change. It first started in the 1990's or the "Decade of the Brain" when neurologists and psychiatrists decided to focus on what happens inside our heads instead of what we manifest as speech and behavior. This line of research continues at such places as the Amen Clinics where therapy is prescribed only after a definitive diagnosis is made only after a full history is taken (including input from family and friends) and a full physical exam is performed. Additionally, brain-imaging studies are used to narrow down the possible diagnoses and the patient can then be treated with the medication, dose, and timing specific for THAT individual patient: (Note: I don't approve of Amen's commercialism. The whole thing reminds me of an Infomercial. But the science is still good).
Which brings me to the crux of today's blog. A friend of mine works at a company that uses genetic tests to determine proper medication use for a whole host of "regrettable maladies," from breast cancer to depression. Yes, depression. Remember Dr. Mangold's Rule of Psychiatry: in the long run, psychiatric problems are neurological issues. Check out the site if you can. They are located at Print up their brochure and bring it to your doctor if you think you can benefit from their testing. Make sure your doctor is listening.

Tuesday, October 29, 2013

The One Good Thing About ObamaCare

I'm not a fan of the Affordable Care Act for many reasons, not all of them political. Essentially, I don't think politicians and bureaucrats should be making medical decisions. Some day I will write about this in more depth but today I want to let you know about the one thing I do like about ObamaCare.

As the program develops, hospital systems (face it, hospitals as we knew them are dead) will be forced to see more and more patients and get paid less and less to see them. Right now, a hospital system or clinic would be lucky to receive 20 cents on the dollar billed. That is not due to over-billing in the first place but rather to the fact that reimbursements are approved or disapproved by bean counters pouring over charts and converting a human activity, a sacred encounter between doctor and patient, into numbers. A lot is lost in the translation.

Remember these facts and you will begin to understand how health care works in the U. S: it's all about motivation and intention. A physician or nurse is motivated by two factors: the profit motive so that they can feed their families and enjoy a decent quality of life and making people better. Sometimes the two motives pull the same weight within an individual practitioner while in another one or the other motives is more important. Sometimes they change rank depending on the provider's personal and professional circumstances.

A hospital system on the other hand is motivated first by the profit motive (hell, maintaining the CEO's pool is expensive) and secondarily by image. While the first is never mentioned in public, take a look at the ads hospitals pay tremendous fortunes on and see for yourself. "Our hospital performs the most heart surgeries in the state;" "Our hospital has a 5-star rating in ..." and so on. Changes occur when hospital systems feel that their profits or images are at stake.

Lastly, the government-run insurance programs are motivated by two factors: saving as much money as possible and providing members with access to health care that is adequate at worst and exemplary at best. The former explains why we see only twenty cents on the dollar but it will also explain why I think something good is going to come out of ObamaCare. It can be summed up in one phrase: preventive care.

My friend, economist and financial adviser John Mauldin writes with a style and clarity that can only be described as inspiring. I'll give the link to an article that describes how the ACA is going to force hospital systems to change in order to stay in business. I'll let John delve into details. What I find ironic (and sad) is that we have been saying the same thing for the last 23 years. Preventive care saves lives and money in the long run. With very few exceptions (and you know who you are!), I feel like I've been preaching to the wall. But with the weight and influence of large hospital systems, the message will reach the masses.

Briefly, consider the cost of treating a patient with heart disease compared to the cost of teaching people how to eat and exercise in order to prevent heart disease. Again, a large segment of the adult population suffer from Metabolic Syndrome which is earmarked by obesity, hypertension, and insulin resistance. This Syndrome inevitably leads to Diabetes Mellitus II and all of its dangerous complications such as heart disease, circulatory problems, mental health issues, and more. I personally have gotten patients off of cholesterol and diabetes medications through diet and exercise alone. At the front end, this saves money on medications and in the long run, saves money on more intensive interventions such as surgery and expensive drugs.

Someday I'll write about what you can do right now to experience better physical and mental health without resorting to medications and surgeries. On your part, please look at Mauldin's article and understand why I have hope for the future.
Dr. Mike

Thursday, June 27, 2013


It's 3 am Thursday morning and I just finished my first book with the above title! Who should buy this book when it is published? Anyone who has ever been a patient. Anyone who has never been a patient. All med students, NP's, PA's, EMT's, Paramedics, and MA students. And those scared of doctors like children and hospital administrators.
Also for anyone who has walked into a clinic, saw the doctor, then walked out thinking "what the hell just happened?
If you think in your own mind that you "know better" than your physician, then read this book and show her the error of her ways.
Read this book then begin to use it like a medical journal of your own health and wellness. Did Dr. Pitel do all the things a good physician does as explored in the book or did he leave something out that Dr. Mangold said should have been done? Or did the medication Dr. Poofandsmoker from Hartford Hospital give you match up with your story and his six minute exam? Did he explain side-effects and med interactions with you or did he punt that off to the pharmacy tech instead?
So please pass on the word. It will only be published as an eBook available at for a very reasonable rate. Click on the amazon link to the right to take you there.
Comments and criticisms are welcome but may make me cry.
Thanks all. Get out the word.

Thursday, June 20, 2013


   Stream of consciousness tonight. Watched "The Hobbit" with the Young Padawan, the Cowboy, Blair Corbett of Ark of Hope fame, and Gimli, son of Gloin. The Cheshire Cat would pounce in and out of the viewing area while the Cowboy seemed to think that the chair and his bed were interchangeable living arrangements.
   Gandalf healed Thorin with prayer. In my practice, that occurred 10% of the time. Can I prove it? No. Prove I'm wrong.
   Angie once bragged that her brother was a great photographer because he had a lot of great photography equipment. I still won't let her live that one down. In photography as in medicine, there are paths of knowledge where critical factors overlap. My own father was a professional photographer. One of my best friends was the photographer extraordinaire Dan Harris. They both trained on high-tech equipment (the more they learned, the techier it became. Did I invent another word?).They could also take outdated equipment and playfully create works of art.
Using whatever equipment you have available and trying to make a diagnosis is similar. It CAN be done with the most expensive toys found in any hospital. Trust me, they won't be in your local clinic. It can also be done through listening to a patient carefully and doing a thorough physical examination. The use of extra tests usually serves to verify a good physician's suspicions. A bad physician will run batteries of tests to arrive at something, anything. There is an old saying in medicine that if you run enough tests, eventually you will find something abnormal.
Abnormal. What if there was a test that created "abnormals" that were ill-defined and vague. How do you interpret that and how do you treat that? Aurora Health Care in Southeast Wisconsin discovered how to do that AND make money doing it: We heard of these tricks Aurora was pulling when an ostracized cardiologist came to our clinic and repeated to us what he saw with his own eyes. When he complained about it, he was let go unceremoniously and lives with the bitterness of knowing that there is no "Employer Retaliation" protection against whistleblowers in the state of Wisconsin. The state brags there is. Believe me, there isn't.
   I will be parachuting for the first time next week. No, I will not have a Golden Parachute like the ex-CEO of Aurora whose termination package amounted to more than $20 million. Ironically, the company stopped construction recently of one facility because they were $20 million behind in projected costs.
   So the take home message today is this: hospitals are not the hospitals our grandparents and even parents knew when they were younger. They are hospital systems and their bottom line is profit. Second in line, image. Third, helping people get better. A physician's and nurse's bottom line is making people better. Profit should come second. Sometimes job security or the security of a steady paycheck has more pull than pure profit. Sometimes profit wins but really, it is patient care.
   Say a prayer for me on the 23rd when I sky dive for the first time in my life. I hope my knees can take it.

Wednesday, June 19, 2013


Charles Knotbrite came to our first garage sale and introduced himself as a Christian who was interested in our mission work. For everyone's reference, we consider ourselves on a mission from God to bring quality health care to underserved areas of the world. Our primary purpose is to serve, not necessarily to "convert." This runs counter to what many in evangelical circles consider "mission work." Our drive comes straight out of Matthew 25 (NIV):
34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’
37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’
40 “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

Asides aside, Charles wanted to know where our mission work was taking us. "Well, Nicaragua for starters" I replied. "Nicaragua? Good luck with that. Ortega is a crazy man." Which was a conversation-stopper.

Unlike Jenny Wai, at least Charles Knotbrite knew where Nicaragua is. I worry though that he is not only making political judgments based on listening to radio commentators but also making medical diagnoses without enough real information. Part of my training was in psychiatry and the two top diagnoses during my clinic years were psychiatric diagnoses. Yet I would not dare make a diagnosis of Ortega's mental status based on what I read in newspapers or hear on the radio. Mountain-making out of molehills? Maybe a little but I really resent having my dreams belittled by people who have never even left their home states. At some post in the future, I will go over psychiatric diagnoses and the importance of the neurological basis for psychiatric disorders. For now, I want to take the bible quote above and show you how we tried to follow Christ's commandments when it was easier to donate money than it was to physically serve.

1. Feed the hungry: local food pantries; Hunger Task Force (
2. Give clean water to the thirsty: Water Missions International (
3. House the homeless: Habitat for Humanity (
4. Clothe the naked: Salvation Army (
5. Visit prisoners: Voice of the Martyrs (

Although not listed in this part of Matthew, Jesus also commanded us to take care of orphans and widows which has also been a significant part of Judaism since Moses' time. Today I would like to give a shout out to Ark of Hope in Florida which has done one of the best jobs of taking care of neglected and (sadly) rejected kids that I have ever seen. Visit them at when you can.

Wednesday, June 12, 2013


I cannot understate the importance of lighting after dark in what the good people at mpowerd call "energy impoverished" areas of the world ( From the GravityLight ( site:
"There are currently over 1.5 billion people in the World who have no reliable access to electricity. These people rely, instead, on biomass fuels (mostly kerosene) for lighting once the sun goes down.

The World Bank estimates that, as a result, 780 million women and children inhale smoke which is equivalent to smoking 2 packets of cigarettes every day. 60% of adult, female lung-cancer victims in developing nations are non-smokers. The fumes also cause eye infections and cataracts, but burning kerosene is also more immediately dangerous: 2.5 million people a year, in India alone, suffer severe burns from overturned kerosene lamps. Burning Kerosene also comes with a financial burden: kerosene for lighting ALONE can consume 10 to 20% of a household's income. This burden traps people in a permanent state of subsistence living, buying cupful’s of fuel for their daily needs, as and when they can.

The burning of Kerosene for lighting also produces 244 million tons of Carbon Dioxide annually."

Decent lighting impacts several areas of the SCANCAPS model of human needs: safe housing, clean air, and reliable means of power production. It also affects medical care, in some cases very dramatically. After witnessing births in Nigeria by "any light source available" (including cellphones) Laura Stachel and her husband Hal Aronson developed the "solar suitcase" to make lights available at all hours of the night. Their mission can be found at

This is just the beginning of my own mission to fill those human needs. Please visits these sites (and and do what you can to help. At the very least, spread the word that there are unmet needs and we have the resources to meet them. Thanks for any help you can give.

Thursday, June 6, 2013


This post will be brief because of time-constraints (yes, even Minimalist Sojourners are pressured for time at times). I'll delve into this deeper later when I talk about basic human needs and SCANCAPS, but for now I'd like to introduce you to two companies that are working to bring light to what the good people at mpowerd call "energy impoverished" areas of the world. Their contribution is the Luci Light. We ran across it at an outfitter's in Boone, NC and fell in love with it immediately ( The other company is Nokero ( We ran across them at the Global Health Initiative at Yale last year when they were just starting-up. We still have the solar-powered light they sold us then. We gave it to the Young Padawan and it has held up well under very strenuous conditions. I'm afraid growth or success may have gone to their heads, though: the responses to our last emails to them were stock "go to our website to make your online purchase" replies. Oh well.

I encourage everyone to do what they can to shine the light. Patients die in the dark; women give birth in the dark; horrendous crimes are committed in the dark.

Tuesday, June 4, 2013


Way back in April during our first garage sale, we had an antique Victrola (that's the first green audio gear for those of you too young to know) appraised by an antique dealer for $1750. He unfortunately could not take it since he already had too many in his shop. He did advise us to take the first offer above $750 even if it felt painful.

It felt painful to let it go at any price. MY value for it was considerably higher than $750 so even an offer for that would've seemed like a jilt to me.
Now it's garage sale time and no offers over $150. What's preventing me from selling it at $150? Pride. How DARE anyone even consider that offer? This is an antique after all. This gorgeous piece of early 20th Century craftsmanship has adorned the living spaces of several homes and has lasted through two marriages and 7 children. No garage sale offer could come close to the value I placed on the Victrola.

So I am trying to figure out how my "desire" to have this piece of merchandise fits in with my true needs. I really valued it yet what was the driving force behind that?

I think we felt  the large amount of truly wothless stuff we accumulated was a form of insurance. Surely selling all this stuff would help propel us forward into the next chapter in our familys life. Selling this amazing stuff would help us financially meet our basic needs.

The Victrola among other things had become a golden calf. I realized this clearly when selling it for far less than appraised value made me angry and upset. Instead of trusting in Gods provision, I had mistakenly placed all my bets on that Victrola. That Victrola should have paid for several plane tickets. It couldnt. It was just an old, decorative piece of wood.  It wasnt created or designed to support the heavy weight of all my needs and desires.

However God does promise us a future and a hope.  Our hope and faith had been mistakenly and momentarily misplaced.

All these idols get in the way of an incredible and intimate relationship not only with God but it also interferes with our relationship with other people. We are excited about living a life of simplicity, one that focuses on time-relishing relationships with people, not with stuff.

We can't wait to take all of you with us.  Imagine the places we will go!

PS: For those of you interested in what most professionals consider "true needs" you can continue reading here:

Recently, psychologists and cross-cultural anthropologists have generated lists of basic human needs. Notice there is no mention of a Victrola anywhere on the list.

From Wikipedia: " Doyal and Gough point to eleven broad categories of "intermediate needs" that define how the need for physical health and personal autonomy are fulfilled:
Adequate nutritional food and water
Adequate protective housing
A safe environment for working
A supply of clothing
A safe physical environment
Appropriate health care
Security in childhood
Significant primary relationships with others
Physical security
Economic security
Safe birth control and child-bearing
Appropriate basic and cross-cultural education.

More later.

Sunday, June 2, 2013


We're at Lees-McRae College in Banner Elk, NC today (Sunday, June2) studying physics and biology through Landry Academy. Yesterday was whitewater rafting day on the Wautaga River (pics to follow as soon as we order them. I didn't bring my cellphone for obvious reasons). Within four days, Angie and I had two extremely opposite experiences with 20-somethings (Generation Y'ers) which illustrate our despair with this country and also our hopes for restoration.

But first, a few lessons from whitewater rafting day:
1. Never wear jeans if there is a chance of them getting wet. Jeans will get wet from rafting. I knew this from my one prior experience in Boseman, Montana and from being an avid ultralight backpacker (
2. Wear scuba booties instead of athletic shoes.
3. Use waterproof sunscreen. Especially if you are white, balding, and haven't seen the sun in six months.
4. If the expedition leaders offer you a free t-shirt at the start of the trip, take it. Pride is cold.

Last Wednesday, the last day in our house, I took Angie out to eat at Uno's. While a corporate restaurant, you can find food that nourishes instead of fills. We met three Generation Y'ers working there: two females and our server who is male. For the sake of brevity, I am going to combine them into one umbrella person I will call "Jenny Wai." I know it's not nice to generalize especially while talking about negative aspects of a population, but I'm sure anyone who has to deal with them can relate. And every experience related here is true, word-for-word if in quotes.

When we explained to Jenny that we gave up almost everything intentionally and intended to tour the country before heading to Nicaragua, Jenny wanted to know if Nicaragua was a city or a country. We said it is a country and asked her if she knew where it was. "Europe," she replied. Really, it's not, Jenny. It's in Central America. "Well, I was close," she said as if we just kicked her in the head, holding her palms apart about 8 inches. Probably because on the last atlas she looked at, they WERE 8 inches apart.

Jenny graduated high school last year and is taking a year off before she heads to college. What does she intend to study? "I don't know. I like everything. Like maybe film making. Or computers. I'm having a hard time narrowing it down." How about cartography, I asked (heck, I am known for my sarcasm). "Oh yes, that's possible. I like everything." Do you like working here? "It's a job. I'm going to leave in a year to go to college."

Fast forward three days. After a great time on the Wautaga River, we were referred to a restaurant in Boone, NC by our raft guide Joshua. The restaurant is Hob Nob Farm Cafe ( and our server was a college student named Sophia. True name and very appropriate. That will be my nickname for all of the Gen Y'ers who have goals and some sense that there is a whole world out there that needs exploring and healing. She attends Appalachian State University. After high school and before starting college, she spent a year in the Peace Corps in Uganda. SHE knows where Nicaragua is. She understands that people there can live on $1 a day (she did it herself), and she knows that we can make things better for people. I will leave that "better" intentionally vague for now: first because it is dependent on each person's ability to interact with the world and second because I have my own concepts of to make the world better which I love and which I have developed over years of glorious and painful trial-and-error.

Sophia and her friend Emily (another server we talked to), renewed our hope for the future. The fertile ground for their growth was not the university but rather their employer, Hob Nob Cafe. When we asked Sophia if she liked working there, she replied with exuberance "I absolutely love my employer." Briefly, the owners grow most of their own food for the restaurant. For the rest, they buy from local organic farmers. Servers are limited to 8 so that each position is coveted by the local candidates. Employees are encouraged to make the cafe better and rewarded for their creative ideas. They are paid well since the cafe refuses to take credit or debit cards. The 2% fee they save goes back into the local economy instead of to the large banks that control the U.S. economy.

I'd like to thank Sameer, a college professor from Florida who was visiting here and who let Jon play on his tablet while I wrote this blog. I didn't even ask him: he just did it on his own. There is hope:

Friday, May 31, 2013


So much has chnged in our lives since the last blog that what I wrote then seems superfulous now. We really thought that semi-retiring and seeing the world in an RV was "minimalist." After 6 weeks of a continuous garage sale (craigslist got tired of us I believe) and an unexpected dream job offer, we nixed the RV idea, changed our criteria for the material stuff we considered "necessary," and focused on carrying our house on our backs and with the car. Yesterday (May 30th) we crammed the last of our stuff into a car top carrier and left Slinger for good.
We have learned many life lessons in the few months I decided to sell the clinic. Since this post is just an update, I'm not going to wax philosophically today but plan on sneaking them into future posts.
I'm going to enjoy the Smokies now so God bless you and I'll talk at you later.

Sunday, April 28, 2013


Is the NutriBullet an adequate substitute for the VitaMix? We usually make one serving at a time in the VitaMix anyway. Can the NutriBullet pulverize food as well as the VitaMix can?

Saturday, April 20, 2013


Day 1 of garage/yard/house sale closed earlier due to hail. Yes, hail. And thankful too since I tired of the women trying to get stuff for free. Pitiful. One showed up with only $100 bills and said it would be "silly" for her to break it just to buy $4 worth of books. One said we should give her some furniture because we "don't need it." Another said her husband lost his job so she couldn't "afford" to pay for the things she wanted. Really? Round 2 tomorrow.

Sunday, April 14, 2013


We sold a few things today prior to our big garage sale next weekend. We are torn at times trying to determine what to sell and what to keep. For me the problem was evident with books. For Angie the issue was what to do with sentimental items. I had a little heart-tug yesterday while sorting books but really, how many do you NEED?

Tuesday, April 9, 2013


It's cold and rainy today and I walked several miles in it from the blood donation center to the library. Now I'm cold & wet and as an ultralight camper I should know better. So, here's the gist of my post: what do you recommend for minimalist outerwear? I'll post my thoughts later after my fingers thaw.

Monday, April 8, 2013


This post is about the OTC medications I think every family should stock whether you are on the road or not. One legal caveat: even though I am a physician I cannot possibly know everything about you (like allergies and other co-morbidities) so take my suggestions and apply them wisely to your own family's situation. Many of the medications can be found in dollar stores so an initial cash outlay should not be cost-prohibitive.
1. Anti-fungal ointment. Adults can use tea tree oil but it is much more expensive, takes longer to work, and can be toxic to children.
2. Loratidine for allergies.
3. Benadryl for acute allergies and insomnia.
4. Aspirin. Not for kids.
5. Generic Tyleniol.
6. Ibuprofen or naproxen (more expensive). The last four for pain, fevers, and where applicable, inflammation.
7. Pepcid or Zantac (generic equivalents) for stomache aches, indigestion and reflux. My wife uses ginger tea for this.
8. Duct tape for warts.
9. PMS tea and Evening of Primrose Oil for "women's issues."
10. Antibiotic ointment. Good stuff, not systemic.
11. Oxymetazoline nasal spray for congestion. Alternate nostrils every 12 hours so you don't become "addicted" to it. Ibuprofen and naproxen also help since a part of congestion is due to inflammation.
12. Delsym syrup for coughs: 12 hour dosing!
13. Imodium-AD for diarrhea. Also orange juice diluted 50% with water for rehydration.
14. Caladryl lotion for local rashes.
This is what we have now. If I think of something I missed I'll let you know.

Sunday, April 7, 2013

CLOTHES: a minimalist approach

What clothes are absolutely necessary as a freedom traveler? For myself, I'm thinking of the following:
1. One pair of blue jeans
2. One pair of cargo pants
3. One pair of shorts
4. One pair of swim trunks
5. 2 gray undershirts (in my case with a pocket to hold my glasses)
6. 3 pairs of underwear
7. One dress shirt for churchin' it up
8. 2 short-sleeved shirts
9. 2 long-sleeved shirts
10. Hooded sweat shirt
11. Pair of sweat pants
12. 3 pairs of white socks (same size and brand)
13. 3 pairs of black socks (same size and brand)

Footwear and coats/jackets will be discussed on separate posts.

Any thoughts? Any recommendations? Is this enough? Is this too much?

Saturday, April 6, 2013



Which kitchen appliances do we absolutely need? I've been thinking about this and I'm trying to decide on inclusion criteria. Multi-use first. The VitaMix salesman at Costco says it replaces 30 other appliances but was unable to name all 30. I can think of these: blender, juicer, nutbutter maker, grinder, possibly a food processor although the shallowness of a food processor has its advantages.
Any thoughts? We have a VitaMix already so we're going to take it with us anyway but what else can we give up?
Other considerations: size, electrical consumption, ease-of-use, clean up.

Friday, April 5, 2013


We're trying to integrate an "organic" approach to health, education, nutrition, politics, religion, and basically life in our quest for freedom and peace. Sometimes one has to strike at the roots.

Moving up and out

     Coffee in hand this cold but sunny early April morning, I'm beginning a new blog site about the new life we have chosen for ourselves. On February 18th, 2013 I retired from clinical practice and moved into academia. Due to the blessings of modern technology, I am able to educate without being tied down to any particular location. So our family has decided to take this show on the road.
     I started this blog to not only chart our progress but to also get advice from those who have gone before us and to get public feedback on our decisions.
     Welcome to UPWARDS BOUND and I look forward to your comments.
--- Mike Mangold