Charles
Runels, MD
Charles
Runels, MD
Start by listening to all 4 of these recordings by clicking on the links: 1. Click to listen to Categories of Health 2. Click to listen to Exercise Without Anchors 3. Click to listen to Individual Hormones (why you've probably still not had the correct tests done and what should be done) 4. Click to listen to Principles of Fine Tuning the Female Body
When women come to visit me from around the country so that I might improve their body and their health, they usually come with some degree of embarrassment. Unfortunately, they’ve been told by several physicians that they suffer with no discrete disease (except perhaps hysteria). So they almost creep to see me. Let me explain where these women exist on the scale of health and why they’ve been misunderstood (so that you may know why they usually go home happier and healthier after visiting me).
When I worked as an emergency-room physician, I mostly cared for people who were either near death or worried that they were near death. The opposite extreme of health would be those who enjoy surplus energy, focused concentration, a body that looks and feels young, and a libido that provides romance and excitement. Between these two extremes lives those who battle chronic diseases like hypertension, high cholesterol, obesity, arthritis, and slowly progressing dementia. These diseases provide the focus of most primary care physicians. The usual care of those who suffer with these diseases demands time, patience, and expertise in the medications used for treatment. Stay with me because I’m getting to an important point about the women who come with embarrassment to see me.
Just a notch or two up from the very ill who saw me in the emergency room, live those unfortunate enough to suffer with severe disease: cancer, bed-binding arthritis, severe emphysema (that harnesses to oxygen). These again require the attention of the expert primary care physician. To pass board exams for the specialty of Internal Medicine, I needed to understand how to treat chronic disease and the critically ill. Now, here’s why the women who see me have been unsatisfied with their previous physicians attempts to improve their health...
About two notches below the state of abundant health, there lives the woman who feels her health spiraling down but who can find no reason for the spiral. She may perhaps suffer with hypertension or high cholesterol and may take medications for those problems. Perhaps she’s had a hysterectomy and takes hormones for replacement. But, these problems do not bring to her the troubled sense of spiraling down that brings her to me. Her problems are more vague. She’s works to concentrate and struggles with memory and calculations that came easily only a few years ago. She’s gained 20 to 60 pounds and cannot find a way to lose the weight. Her libido’s gone or greatly decreased and brings some stress to her marriage and perhaps a loss of sparkle to her personality. She’s more irritable with her family and feels like there must be a hormonal or metabolic reason that has not been identified. She’s depressed about the changes in her body and feels like the spiral can be slowed or stopped but cannot find a way. She may be anxious and suffer with difficulty sleeping. Her hair’s thinning, her skin’s aging, her bowels slowing, her muscles sagging and she only hears curt answers or no answer at all when she tries to talk with her physician about the problem. But, she really shouldn’t blame her physician. Let me explain.
I did very well on board exams and saw not one question on those exams that applies to solving her problems. All the knowledge base that I was required to collect in my skull dealt with the other categories of health: severe disease and chronic disease and acute disease--not one fact was required dealing with the care of those near good health but not quite there
As evidence to how behind conventional medicine is to the practical application of health improvement (as opposed to treating with medication those who are ill), consider this: Shockingly, when I interviewed for medical school (back in the 1980's) the New England Journal still printed scholarly debates between ivory tower physicians about whether or not aerobic exercise was helpful or harmful. I recently attended an intensive review of Internal Medicine at Harvard University. This review attempted to provide an overview of recent principles in managing the general health of patients. I’m not exaggerating when I say two sentences were uttered about diet in the whole series of lectures; when discussing hypertension and high cholesterol, the prominent expert recommended that physicians try diet and exercise before beginning any medication. But, not one word was uttered about how that diet and exercise might best be administered.
Think about this for just a moment. The first choice for therapy warranted not one word of explanation or expounding upon. Yet, many hours were devoted to the proper administration of second and third choice therapies–prescription medications. This method of educating physicians explains why your physician may look blankly at you when you have a problem that demands therapy that may not require medication.
This gap in the education of physicians also explains why many find more help from the cashier at the health food store or the exercise guru at the gym than from their physician (and why billions are spent on non-prescription therapies). But, wouldn’t it be nice if you could visit with someone who understood the exercise, the nutrition, the vitamins and herbs, and the details of the endocrinology, physiology, and pharmacology required of the physician?
I believe that every primary care physician should be the person just described. So, why aren’t they? Understandably, physicians must base their therapies on research proven treatments. Research requires money. From where do you think most of the money for research comes? Those who make medicine pay for most of the research published in this country. The National Institute of Health (NIH) pays for some research, and there are other means of support but most of the data comes from the drug companies.
I don’t find it disturbing that drug companies sponsor research. Their research does save lives. The tragedy exists in the skewed amount that’s been done on the medication side. This vast body of research on medication compared with the little that’s been done on lifestyle changes and their effects explains why doctors are so uneducated when it comes to helping their patients change their lifestyle or find other therapies that do not involve prescription medications. We physicians receive education about what’s been tested and proven and mostly what’s been tested and proven involves taking a pill that you buy at a pharmacy.
The other hindrance to caring for women in the never-land between excellent health and chronic disease is that it usually takes about 10 years to prove a new therapy effective and about another 10 years for it to become common practice. When I worked as a research chemist, I was rewarded for new ideas. In fact, if I didn’t come up with new and better ways on a regular basis, then I would soon lose my job. This changed dramatically the day I started medical school.
Though when I do medical research, I’m rewarded for my efforts, if I try to apply a new therapy that I consider to be proven, I risk being labeled a maverick or a quack and of losing my license. The question is how much research should be done before a new therapy is considered proven and so should be started on every patient to who it applies. There’s no simple answer to this question. So, even though much new research has been published in the past 10 years concerning hormone replacement, diet, supplements, and exercise (therapies that may be helpful to those who need a Tune-Up), most physicians are either unaware of the new information or are reluctant to apply them because they either don’t understand the research or because they fear leaving the herd. This is why you had physicians debating whether aerobic exercise should be recommended to people for 10 years after the initial research showed it to be of benefit.
So, when a woman over 35 shows up in the office of her primary care physician and her problem cannot be solved with a prescription medication, she may receive a blank stare or a curt answer; but the physician’s not to blame.
First, I try to focus on the women and men who are lost in the never land that’s near good health but with evidence of a spiral down. Rather than wait until they hit upon serious disease (as I once treated in the emergency room), or until they fall further into a more serious chronic illness (as I treated in a more traditional practice), I enjoy researching both the literature and clues offered by to the person in front of me to find the most powerful way to stop the vague sense of spiraling down that’s evidenced by weight gain, fatigue, mild depression, decreased libido, loss of muscle tone, and all the other things that prompt the blank stare from your primary care physician. This process of focusing upon and specializing in the area just below excellent health is what I call "Fine Tuning" the body. It’s analogous to tuning up a fine automobile rather than waiting until it’s broken down to take it to the shop.
Second, I try to stay very current so that I can offer what’s needed. To me staying current means reading the New England Journal, attending conferences, doing medical research, and all the other traditional educational tools; but it also means talking with the owners of health-food stores, reading the popular books and the fad diets, talking with athletes (who sometime do their own experiments), going to spas and health resorts, studying the eastern thoughts on health, trying things out myself, and--very importantly--listening carefully to every person who visits me.
I’ve worked as a research chemist, personal trainer at the YMCA, passed board exams for Internal Medicine and ran a general practice for a few years, taught nutrition classes, taught swimming classes, taught classes in emergency rescue (at local college), managed a hyperbaric chamber (pressurized oxygen therapy) at a local hospital, worked at physical rehabilitation and drug rehabilitation hospitals, visited prisoners in the general population and on death row, studied and gathered herbs from the forest, studied meditation in the mountains of Georgia, I’ve studied Yoga and massage. Still, I come with fear and reverence to every person that comes to me for advice. But, I also come with anger at disease and at discomfort–enough anger to recommend whatever I think may bring benefit with little risk. There’s a general sense of fear among physicians: fear of attorneys, fear of patients, fear of leaving the herd. Good therapy in my opinion involves enough education to allow a humble but determined and fearless approach. I try to bring therapy without fear of politics and with a general view of all possible helpful therapies, especially those without medication. If medication is the best therapy, however, I will recommend it. Sometimes, nothing with lifestyle will work. Try treating an acute heart attack with a lifestyle change. Some processes are so far advanced that medication must be used. After lifestyle changes are put in place for period of time, medication may sometimes be reduced. I always inform my patients what’s standard and what’ experimental, and what’s caught in the gray area (good evidence and accepted by some but considered unproven by others). Educating patients takes time but people seem to benefit with better health when they know all the choices and decide for themselves what path to take.
Often, when I meet with a new patient, she’ll be resistant to some of my suggestions. It won’t necessarily be that I’ve offered something difficult to do. What bothers her is that it’s either not what she’s heard from the person that’s been advising her or it’s not what she wanted to hear. Let me give an example.
I do not know one person (and have talked with thousands) who had a problem with weight gain who then lost weight and kept it off without either walking or jogging. Notice I put several qualifiers in that statement. I’ve known a few genetically fortunate people who maintained normal weight with almost no physical activity. But, of those I have either met or coached from overweight to sustained normal weight, not one did it without walking or jogging. Unfortunately, the new fancy machine you bought will not likely work (unless it’s a treadmill or elliptical trainer, both of which mimic walking). Unfortunately, riding a bicycle or swimming will not likely bring you to your normal weight. Unfortunately, lifting weights will not likely bring you to your ideal weight unless you add to the weight training some walking (though weight training combined with walking gives probably the best health and most beautiful body).
So, if you’re overweight, I simply do not think you will reach and keep your normal weight until you find time to walk and walk much more than you’re probably walking now. I'll help you find what metabolic or hormonal problems keep you from finding the energy to walk and inhibit your recovery from exercise. I’ll offer you advice on how to actually find more time in your day when you walk. I’ll offer ways to make the walking actually something you enjoy and happily anticipate. But, I simply cannot offer you a way to lose weight and keep it off if you are obese and refuse to walk–even if your mother, trainer, sister, or health-food store guru tells you there’s another way.
Remember, what I hope to offer you is 30 years experience in both the world of medicine and the world of nutrition and fitness and spiritual health. If you wish to try out my teachings, you must be willing to try them. I don’t have the energy to argue with your mother. I recommend that you try all of my suggestions at the same time and drop (at least for a time) any conflicting advice if you wish the full benefit of the synergy of ideas presented in the booklet.
Bottom line, a common trap that keeps people from benefiting from my experience is that they simply will not try the simple suggestions that I offer them.
When I was in my early teens, my maternal grandfather retired from his job as a baker. He’d worked for about 40 years as a baker at a shop in Birmingham, Alabama making cakes and pastries and breads. He told me something a few days after his retirement about baking a cake that applies directly to the present discussion.
He was ahead of his time and really enjoyed making the heavy breads. He was German and loved to make very heavy, whole wheat breads at a time when most of the locals wouldn’t touch the stuff. Most of the profits from the bakery came from the delicious and beautiful pastries, cakes, and pies that he baked. When he retired, they asked him for his personal recipe book. It consisted of a spiral bound notebook filled with hand written lists of ingredients mostly measured in pounds since he baked such large amounts in this commercial facility.
While at his home one day and while watching him grind up vitamins in a blender to throw into his whole wheat bread, he told me that he gave them the recipes but they wouldn’t be able to bake the cakes. "It’s not just know the ingredients it’s know how to put them together," he said.
I think anyone who’s ever baked a cake knows the truth of this statement. But surprisingly, people who recognize the complicated nature of baking a cake, will think that managing health can be done in a simple manner. There's a standard criticism you'll hear the older physicians sometime mutter about those less experienced, "He's practicing cook-book medicine." What the experienced physician realizes is that the younger physician may know all the ingredients, but he's still working on how to bake a cake.
It’s not just knowing about nutrition, herbology, exercise physiology, pharmacology, pathology, endocrinology, and psychology that gives the ability to turn someone’s health and life around. It’s being able to listen to someone and know when to add each ingredient. That’s where spending a few years in the kitchen baking cakes can come in handy.
One of the problems with changing a person is that some of the ingredients must be added by the person. If we meet and I think the next ingredient to add is to walk 3 blocks every morning and take a B complex with breakfast, that does not mean that we’ve completed the recipe.
First, you should add those ingredients. Then, when we talk again, you tell me how the mixture’s working and we decide together on the next ingredient to add. With cakes you may fold in a few ingredients and then mix for 2 minutes. With medicine, you may change a few hormones then wait one week and alter activity level.
After a time, if we’ve got the correct recipe and mix the ingredients intelligently, you will notice the construction of better health and an improved life. But, there is some art to the process; not simply a list of ingredients.
If you add the ingredients when suggested, give me plenty of feedback about what’s happening in the oven, and then go to the next step, you do the most to assure a new body and a new outlook.
If you leave out an ingredient or two or change the order and process of mixing and cooking, I can’t feel as assured about the cake we’re baking.
First, make sure you're enroll in my health lessons:
Read more about thyroid replacement in women here...
How testosterone may help PREVENT breast cancer
Read how testosterone helps prevent and treat auto-immune disease.
Read about hormones and female orgasm here (High Intensity Orgasm for Women)
If you live far away from me but still live in the United States, I can still check your blood hormone levels and advise you by phone. Click here to learn how.
If you wish to talk with me further, call 251-648-7704
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Female Hormone Replacement
