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About me:  Forest-dwelling father, Finnish sauna fanatic, emergency physician, ED and EMS Medical Director, ultrasonographer, professor, student, photographerfilmmakerauthor, localism entrepreneur. Co-host Conscious Bro Podcast

Selected Projects: 

  • Defiance Springs Lodge - artists' salon. A charming micro pioneer hotel in the forests just outside Viroqua, WI. Our goal was to create a space where one might not be sure of the time period they were in. Is it now, is it 3000 years from now or 3000 years ago? A combination of Little House on the Prairie, Westworld, and The Real World. The Prancing Pony meets Harry Potter meets Star Wars galactic café. Like a 100 acre movie set. As if you were on an Oregon Trail-type adventure, and requiring some respite, ventured upon a lively timber hotel. A literal healing sanctuary along the headwaters of the South Fork of the Bad Axe River. Surounded by artesian springs, rocky ravines, and effigy mounds. An ideal setting to rebalance, heal, and revive.  A community of likeminded resident and visiting filmakers, creators, artists, physicans, healers and entreprenuers. Sharing ideas and content around loving regeneration, in-all-ways. From self to soul to soil. Colletive manifestation of a more verdent valley on the other side of the portal divide. 
  •  Viroqua Public Market, an award-winning adaptive reuse of a historic Viroqua, Wisconsin.
  • The National Transfer Registry app (aka theNTR). This is a directory of every acute care hospital, nursing home and EMS agency in America, a free tool to use during critical transfer challenges.  
  • Regenven, Regenerative Adventures: We seek to leave a lasting positive effect. Optimizing resiliency, through investments focused on a regenerative mindset, from self to society, habitation to habitats to habits. Regenerative adventures.
  • Cobalt Cottage AirBNB Viroqua. On the grounds of the Viroqua Public Market. Super charming entire home that sleeps 10.  Haunted speakeasy vibe. Right in the thick of things.  Experience Viroqua as a local!
  • Serenity Cabin AirBNB Viroqua. Cozy, rustic cabin on forested hillside overlooking trout stream.  Miles of private groomed trails. Friendly goats. Middle Earth vibe. Just five minutes to Downtown Viroqua.  

I am infatuated with this "Driftless Area", a unique and mysterious zone in SW Wisconsin never bulldozed by glaciers - resulting in an ancient, undisturbed lands of artisan spring-fed streams, foggy valleys and magestic rocky bluffs covered in prehistoric oak savannas. A real-world Middle Earth. A destination sanctuary bioregion with an abundance of water, sustenance, energy, connectivity and cooperation. Arguably the richest soil on the planet and notably, mostly controlled by interconnected families.  A geographic locale with an optimal balance of wet and dry, warm and cold, individual and collective, allowing us to not only survive but thrive as the Earth inevitably churns into its next version.

I have playful recurrent dream: This enchanting zone of land, is like an Arc!  And we, the people of this Driftless Nation, venture together upon the waters of a world-wide calamitous flood, on 20,000 year mission to foster collective bliss and leave a lasting positive effect.

      And thus healing is not a destination, but daily practice.

  

F E A T U R E D   P H O T O G R A P H Y

An assortment of my photography our beloved Driftless Area and beyond.... 

 

 

______

F E A T U R E D   F I L M S

 

 

Mindflow Radio Podcast: Inspiration, Motivation and Values. 12 Feb 21

VISION QUESTS

 

Driftless Thrive Podcast, ep. 1 April 2020

 

 

Friday
Nov242023

Passing from one epoch to the next

What will the future bring. A thought experiment beginning 6000 years ago and concluding 6000 years from now.  Based on the Book by Peter Zeihan, The End of the World Is Just the Beginning.  

He demonstrates that our decades long period of hyper globalization is all but over. Our species has sprinted over the last thousands of years from a time where, without brute daily consumption, the baby dies! There was no bandwidth for regeneration. This has carried us forward until today. No judgment. So much of what we have accomplished demonstrates the near limitless potential of our species.  But obviously, perpetual consumption without regeneration is not something that can last.
And in some ways, hyper globalization, may naturally lead to hyper— Localism!
Especially around fundamentals of daily thriving, like food, water, shelter, energy, community.  America has virtually every requirement for perpetual self-sufficiency, again based on your analysis.  
That said, ug, in the near term, we are certainly facing at best a worldwide depression, as the pillars of hyper globalization begin to more clearly fail. We may lose millions upon millions to famine. China decivilizes. The emotional response to this will be overwhelming, but also temporary.
 Then, given the regeneration of the United States into a juggernaut of anti-fragility — and hopefully also coupled with a sense of regeneration of the entire species into more giving and regeneratively minded decentralized groups - we get a harmony between the broader thriving North Americans and thousands of local bio regions and so on. A reestablishment of balance in everything we do. Including a balance between individual prosperity and security and that of the community. Less affected by inflation, centralized currency, government etc by the nature of being small and local.  
Nothing is assured but it’s not impossible. We could one day achieve this, through collective manifestation.  Not saying there won’t be suffering, loss, death, murder. Just won’t be mass murder.  
Our reality is malleable, no matter how you look at it.
So let us band together, combined the wisdom of our grandmothers with our collective brain power and determine the state of our species after we emerge from this epic epoch portal.
Monday
Sep052022

Born to Binge Lifestyle 

 

EM and born to binge!
Here is one easy solution to consider. Pharmaceutical free, painless, and most crucially something you can do the rest of your life.   
***Anecdote alert anecdotal alert anecdotal alert***
I wanted to share my personal experience with losing that 10% of flab. A struggle for the last three decades, solved!  
A true panacea???: 
Born to Binge Diet
 (aka ‘it’s not fasting diet’).  
TL/DR :  Focus on the positive.  Eat well and without limits, do so over eight hours daily. Minimal calories for remaining 16.  That is, this is not about “fasting“ it’s about Binging (so to speak)  
With myself as a test subject this is the only sustainable lasting strategy I’ve ever adopted to rid that ridiculous unsightly blubber around my middle.  
——-
Further details if you’re interested.
Caveats first. My feelings are this likely works well in males. Still not sure if this is wise for females but would love input if anyone is trying this.
Other hacks I’m employing simultaneously which by themselves did not produce the same affects but are probably cofactors:
-All the low-lying fruit, with a goal of minimizing basal cortisol level and maximizing mitochondrial fitness.  No drinkable carbs, mindful of amount of simple carb inputed, living food probiotics daily, daily aerobics, don’t use exercise as a weight loss strategy, exercise in whatever manner causes the least psychological stress.  Must must must have a stress reduction, mindfulness, meditation, prayer , breathing practices to decrease those basal cortisol levels.  Sauna and cold plunge daily.  View bright light for at least a few minutes every morning to facilitate necessary late morning cortisol spike.   Pro tip, use something like the Reveri app and do self hypnosis regularly.  Similarly consider finding a good therapist. Elucidate and then manage all the soul trauma we carry with us. Maximize intimate time with partner (multiple benefits!).  
Background. This strategy was inspired by Mickey Musumeci.  He is a Brazilian jujitsu multiple world champion. During an interview on the Joe Rogan podcast he shared his pasta diet. Basically making his own pizza and pasta, eating as much as he likes and then fasting the rest of the day. He shared this was the most stress-free means to make weight. It’s a great interview if you’re interested. Actually pretty inspiring.  
He is almost exactly my same ideal weight, about 140 pounds.  So though despite this seemingly violating laws of thermaldynamics as mentioned in other comments, for him and again anecdotally for me it absolutely does work.  Perhaps where dissipating dark energy or something lol.
Adaptively it does at least have some face value. Our great great great great great grandfather’s and mothers, whom by definition impossibly survived to create us, probably did some form of this. And the farther back you go, the more likely this is true if you think about it.
Test subject, me. 53 year old emergency physician no medical problems or meds - no dx but have had borderline elevated blood pressures.  Compact frame, 5‘8“.  Borderline hypertension.Half Filipino and has Eastern European.  When I was at Peak during athletic years, say 18 years old, I weighed about 130 pounds. During times in the inner-city trauma center, divorce, no mindfulness practices etc. etc., my peak weight was almost 160 pounds. My hemoglobin A1c crept up to about 6.4. Father has DMII.
Physically, all of that 30 pounds was around my middle, and likely in my visceral organs. So I have the dreaded SkinnyFat. Compact frame with flab in the middle. 
Have casually tried almost every reasonable diet out there from prolong fasting, intermittent fasting / time restricted, Paleo, low-carb. Almost everything does actually work. For a while. Like everyone in the world who diets, would never stick.  It was seemingly overnight, exactly back to where I was. Sometimes even slightly worse.
Exercise. I hate to work out. It stresses me out. So I don’t do it. Instead, I just change the language a bit and it’s just part of a lifestyle. I try to stand as much as possible. A hike regularly. I have the fortune of living on a forest property, so there’s always physical things that have to happen. It’s like a constant fun workout all the time. I installed pull up handles coming down from my cabin loft. I use these two descend and do approximately 20 pull ups, at least every other day. I try to sprint from point-to-point, because I like sprinting and it’s a little bonus workout of lower extremities.  I do one random pose supramaximal Whole body contraction during exhalation, every other day.
During activity goal of keeping heart rate below the aerobic anaerobic threshold, for me at my age it’s about 130. Hack here, as long as you can breathe through your nose, you’re still aerobic!
In the mindfulness realm, I use the app mentioned above every day. I deploy an “air aroma” breathing practice. This is analogous to box breathing or 4 x 4 breathing. My hack is to sample the scent of the air while slowly inhaling, do a little stutterstep physiologic sigh like a baby.  Strive for total lung capacity while doing so. Smelling the air distracts my crazy mind for a second, and clears out some of the gunk. This than leads to a form of self hypnosis, where I connect with what I think of as a divine soul. The self soul melding leads to healing and inspiration.
And as to the diet. So like Mikey I love pizza and pasta.  It’s one of those things that he alludes to that I seemingly could eat without limits.
So specifically I eat as much as I want over a 6 to 8 hour period.  This is always good food, whole-grain pasta’s and pizza, try to make or buy made from scratch. Local ingredients, from my Farmer friends. An outstanding dessert even if hi carb.  I kind of allow myself to gorge actually. It is so pleasurable that not eating for the remaining 16 hours is almost like foreplay lol. It really does result in a net positive. Again by focusing on the positive, the binge and treating the negative, the fast as part of the binge, I feel like my overall will to continue is maximized and the psychic stress is minimized. This is easily something I could do for the rest of my life and intend to.
And because I do Emergency Medicine and the time frames are sometimes less consistent. That is, I focus less on the time of the day and more on the intervals. So if I end up eating a little bit later into the day, say last calories at 10 PM, I simply don’t start my next eight hour binge until 2 PM the next day.  If I want to start eating an earlier time, I accept the occasional shorter fast period period.  My average time is roughly noon to 8 PM. On Night Shift I typically don’t eat anything all day and then in the first few hours of my shift I start my binge.  I know this may sound crazy, but since doing this, I’m actually quite alert by morning still. Not sure if it’s the diet but this is the only time in decades I’ve had this pleasurable wakefulness all the way to 8 AM.
Results. I feel like my ideal weight, not being too skinny, not having blubber is 140 pounds. I’ve been employing this practice for about six weeks now - and counting. After the first few weeks, I step on the scale and I swear been around 139.9 pounds every single day, no matter how much I’ve binged the day before. I feel healthy, energetic and calm. Heart rate averaging around 59. Blood pressures normal. A1c normal.  I have a little adipose around my middle but overall I am overjoyed with my physique.  I feel more vital than I did when I was 18.  
Anyway it’s just my thoughts on this. Love to hear if anyone else again is using this strategy??

EM and born to binge!
Here is one easy solution to consider. Pharmaceutical free, painless, and most crucially something you can do the rest of your life.   
***Anecdote alert anecdotal alert anecdotal alert***
I wanted to share my personal experience with losing that 10% of flab. A struggle for the last three decades, solved!  
A true panacea???: 
Born to Binge Diet
 (aka ‘it’s not fasting diet’).  
TL/DR :  Focus on the positive.  Eat well and without limits, do so over eight hours daily. Minimal calories for remaining 16.  That is, this is not about “fasting“ it’s about Binging (so to speak)  
With myself as a test subject this is the only sustainable lasting strategy I’ve ever adopted to rid that ridiculous unsightly blubber around my middle.  
——-
Further details if you’re interested.
Caveats first. My feelings are this likely works well in males. Still not sure if this is wise for females but would love input if anyone is trying this.
Other hacks I’m employing simultaneously which by themselves did not produce the same affects but are probably cofactors:
-All the low-lying fruit, with a goal of minimizing basal cortisol level and maximizing mitochondrial fitness.  No drinkable carbs, mindful of amount of simple carb inputed, living food probiotics daily, daily aerobics, don’t use exercise as a weight loss strategy, exercise in whatever manner causes the least psychological stress.  Must must must have a stress reduction, mindfulness, meditation, prayer , breathing practices to decrease those basal cortisol levels.  Sauna and cold plunge daily.  View bright light for at least a few minutes every morning to facilitate necessary late morning cortisol spike.   Pro tip, use something like the Reveri app and do self hypnosis regularly.  Similarly consider finding a good therapist. Elucidate and then manage all the soul trauma we carry with us. Maximize intimate time with partner (multiple benefits!).  
Background. This strategy was inspired by Mickey Musumeci.  He is a Brazilian jujitsu multiple world champion. During an interview on the Joe Rogan podcast he shared his pasta diet. Basically making his own pizza and pasta, eating as much as he likes and then fasting the rest of the day. He shared this was the most stress-free means to make weight. It’s a great interview if you’re interested. Actually pretty inspiring.  
He is almost exactly my same ideal weight, about 140 pounds.  So though despite this seemingly violating laws of thermaldynamics as mentioned in other comments, for him and again anecdotally for me it absolutely does work.  Perhaps where dissipating dark energy or something lol.
Adaptively it does at least have some face value. Our great great great great great grandfather’s and mothers, whom by definition impossibly survived to create us, probably did some form of this. And the farther back you go, the more likely this is true if you think about it.
Test subject, me. 53 year old emergency physician no medical problems or meds - no dx but have had borderline elevated blood pressures.  Compact frame, 5‘8“.  Borderline hypertension.Half Filipino and has Eastern European.  When I was at Peak during athletic years, say 18 years old, I weighed about 130 pounds. During times in the inner-city trauma center, divorce, no mindfulness practices etc. etc., my peak weight was almost 160 pounds. My hemoglobin A1c crept up to about 6.4. Father has DMII.
Physically, all of that 30 pounds was around my middle, and likely in my visceral organs. So I have the dreaded SkinnyFat. Compact frame with flab in the middle. 
Have casually tried almost every reasonable diet out there from prolong fasting, intermittent fasting / time restricted, Paleo, low-carb. Almost everything does actually work. For a while. Like everyone in the world who diets, would never stick.  It was seemingly overnight, exactly back to where I was. Sometimes even slightly worse.
Exercise. I hate to work out. It stresses me out. So I don’t do it. Instead, I just change the language a bit and it’s just part of a lifestyle. I try to stand as much as possible. A hike regularly. I have the fortune of living on a forest property, so there’s always physical things that have to happen. It’s like a constant fun workout all the time. I installed pull up handles coming down from my cabin loft. I use these two descend and do approximately 20 pull ups, at least every other day. I try to sprint from point-to-point, because I like sprinting and it’s a little bonus workout of lower extremities.  I do one random pose supramaximal Whole body contraction during exhalation, every other day.
During activity goal of keeping heart rate below the aerobic anaerobic threshold, for me at my age it’s about 130. Hack here, as long as you can breathe through your nose, you’re still aerobic!
In the mindfulness realm, I use the app mentioned above every day. I deploy an “air aroma” breathing practice. This is analogous to box breathing or 4 x 4 breathing. My hack is to sample the scent of the air while slowly inhaling, do a little stutterstep physiologic sigh like a baby.  Strive for total lung capacity while doing so. Smelling the air distracts my crazy mind for a second, and clears out some of the gunk. This than leads to a form of self hypnosis, where I connect with what I think of as a divine soul. The self soul melding leads to healing and inspiration.
And as to the diet. So like Mikey I love pizza and pasta.  It’s one of those things that he alludes to that I seemingly could eat without limits.
So specifically I eat as much as I want over a 6 to 8 hour period.  This is always good food, whole-grain pasta’s and pizza, try to make or buy made from scratch. Local ingredients, from my Farmer friends. An outstanding dessert even if hi carb.  I kind of allow myself to gorge actually. It is so pleasurable that not eating for the remaining 16 hours is almost like foreplay lol. It really does result in a net positive. Again by focusing on the positive, the binge and treating the negative, the fast as part of the binge, I feel like my overall will to continue is maximized and the psychic stress is minimized. This is easily something I could do for the rest of my life and intend to.
And because I do Emergency Medicine and the time frames are sometimes less consistent. That is, I focus less on the time of the day and more on the intervals. So if I end up eating a little bit later into the day, say last calories at 10 PM, I simply don’t start my next eight hour binge until 2 PM the next day.  If I want to start eating an earlier time, I accept the occasional shorter fast period period.  My average time is roughly noon to 8 PM. On Night Shift I typically don’t eat anything all day and then in the first few hours of my shift I start my binge.  I know this may sound crazy, but since doing this, I’m actually quite alert by morning still. Not sure if it’s the diet but this is the only time in decades I’ve had this pleasurable wakefulness all the way to 8 AM.
Results. I feel like my ideal weight, not being too skinny, not having blubber is 140 pounds. I’ve been employing this practice for about six weeks now - and counting. After the first few weeks, I step on the scale and I swear been around 139.9 pounds every single day, no matter how much I’ve binged the day before. I feel healthy, energetic and calm. Heart rate averaging around 59. Blood pressures normal. A1c normal.  I have a little adipose around my middle but overall I am overjoyed with my physique.  I feel more vital than I did when I was 18.  
Anyway it’s just my thoughts on this. Love to hear if anyone else again is using this strategy??

 

Saturday
Oct302021

Perhaps the simplest life hack, optimize how I communicate

One of my favorite podcasts, EmCrit, Recently said that one of the most impactful books ever read is Dr. Rosenberg's, nonviolent communication. 

To me it boils down to this. I often find myself in the trap of being stuck in my own head when I communicate. This over time probably lowers the chance of having truly effective conversations.  I mean, what's the point of communication if it's not effective communication. In other words only effective communication is just communication lol  

 

In my humble interpretation it comes down to this… 
What I’m calling 
ComCom
Which refers to effective communication using compassion for yourself AND for the person your are conversing with. 
The reason to even think about this is given the numerous times a day we are communicating with people for a variety of reasons and degrees of urgency. What if we all set a goal to make 100% of those As mutually effective as possible.
The reason, Everybody lives their best life. There is no Shangri-La but there is some theoretical best possible state.
ComComm has two simple Objectives
 
win AND win.  
Listen 
Deeply 
Within. 
 

Details to follow ….

 

Tuesday
Apr282020

COVID & the Cellular Signal Corps. 

COVID & the Cellular Signal Corps. 

  Tony Macasaet, MD, FACEP

 

Hypothesis: inspired by the heroic, frontline efforts of emergency physicians like Dr. Caleb Hernandez, COVID-19 may, in part, be a leukotriene/bradykinin mediated angioedema-like state, especially affecting the most distal parts of the airways and alveoli. Net effect of viral infection leading to increased vascular permeability, upper and lower airway and tissue edema, bronchospasm, excess mucin production, dysregulated inflammation, thrombosis and eventually epithelial hyperplasia and fibrosis. Fortunately like angioedema, it may be rapidly reversible if treated early with epinephrine, antimuscarinics and leukotriene blockade. Dramatic anecdotal results are consistent with a positive response, suggesting these concepts are worthy of further study.  



Discussion

Medications that MIGHT have benefit and my commentary on mechanisms:

  1. Montelukast po. See review below. Use may lead to less bronchoconstriction, mucus, airway edema, inflammation, and fibrosis

  2. Epinephrine Intramuscular (if inadequate infusion pumps).  Vasoconstriction in increased contractility of course. Increases respiratory rate, bronchodilation, decreased vascular permeability and improved tissue and airway edema. This includes improved upper airway edema if present. Shifts Oxygen–hemoglobin dissociation curve, promoting better tissue oxygenation 

  3. ADH / Vasopressin IM.  Arteriolar vasoconstriction and free water reabsorption. 

  4. Atropine IM.   Muscarinic antagonist - causing decreased respiratory secretions.

  5. Systemic  anticoagulation

 

This cocktail in severe, failing COVID-19 MAY provide:

  1. Decreased upper AND lower airway edema/bronchoconstriction, improving WOB and oxygenation 

  2. Decreased alveolar edema/flooding, loss of surfactant, failure of oxygen absorption etc etc 

  3. Decreased respiratory secretions

  4. Improved overall perfusion and tissue oxygenation. 

 

Strictly my own summary and discussion.  

Montelukast - high affinity leukotriene receptor blocker. Evidence it blocks bradykinin too. 

I had to recall that leukotrienes are signaling molecules produced in immune cells. Made from Arachidonic acid (AA). AA is of course the building block of our beloved phospholipid bilayer and part of numerous signaling molecules. AA itself may have a role in the inflammatory cascade.

Leukotrienes released from white cells bind to leukotrienes receptors on the cell wall of respiratory epithelial cells, airway smooth muscle cells, airway macrophages and other pro-inflammatory cells.  

With binding, leukotrienes trigger cellular signaling, leading to effects such as:

  • Increased release of histamine and prostaglandins.

  • Heightened bronchiolar smooth muscle tone, with small airway bronchoconstriction.

  • Copious mucus production, increased vascular permeability, edema

  • Hyper-responsiveness to bronchoconstriction (some resistance to B-agonists??)

  • further pro-inflammatory cell recruitment.  

  • Not to mention smooth muscle proliferation, collagen deposition, and fibrosis.

  • Increased mucin secretion by goblet cells and respiratory epithelial cell hypertrophy.  So, snot cells on steroids!!

  • Increased permeability of the blood brain barrier. Dysregulation of blood-brain barrier.

Thus, there is at least biological plausibility the above cocktail of somewhat every day medications, in many a crashcart and medicine cabinet has a net benefit. Hypothesis generating.

 

Taking it just a little further, SARS-Cov-2 infects respiratory epithelial cells, gaining access via the ACE2 receptor on the cell wall. The receptor and the virus are involuted into the cell. Because of decreased ACE2 receptor activity, bradykinin increases (normally metabolized by ACE2). This then may lead to increased vascular permeability, bronchospasm, edema etc. etc.  Again, there is research suggesting montelukast blocks bradykinin receptor activity similar to leukotrienes. 

So, perhaps in the end the key will be blocking the effects of bradykinin and or leukotrienes, which may be released as part of COVID-19. That is Montelukast, and good old epinephrine, atropine, and vasopressin. 

Along these lines, other medications to ponder might include: Icatibant, TXA, H1 and H2 blockers, aminophylline, and Cromolyn among others. 


Bottom Line Speculation

Mechanistically COVID-19 may be behaving in part somewhat akin to an angioedema-like process + micro pulmonary/systemic thromboembolism. Leading to catastrophic end-organ hypoxia.  Antagonizing these effects may reverse the seemingly unstoppable death spiral of COVID-19. 

 

 

Sunday
Apr192020

Driftless Thrive Podcast, ep. 1

Inaugural Driftless Thrive 20/20 podcast conference.

Hope, flow, joy and solutions.

Will schedule others - watch for invites!