 Welcome to Much More On Medicine on the Think Tech live streaming network series broadcasting from our downtown studio at Pioneer Plaza in downtown Honolulu. I'm your host, Catherine Noor. Much More On Medicine is an opportunity to learn about all aspects of healthcare. I talk with guests about medical and alternative care treatment, insurance, medication, surgery, rehabilitation, prevention, and much more. Joining me in this studio is Dr. Ira Zunan to talk about the mind and body as one, bringing together the best of modern medicine and traditional healing arts. You may have read Dr. Zunan's Wealth of Health column in the Honolulu Star Advertiser or Cinnamon KITV Channel Forrest Morning Show, The Doctor Is In segment. Dr. Zunan is the medical director of Monacaio-Malama Integrative Clinic and Rehabilitation Center in Honolulu. Here in his medical degree from UCLA School of Medicine, he completed a residency in preventative medicine in Hawaii and earned a master's degree in public health. He received specialty board certification in general preventive medicine and public health and is certified by the American Board of Independent Medical Examiners. Dr. Zunan has also studied Tibetan medicine in India and Nepal and is trained in traditional Chinese medicine as well as being a physician acupuncturist. Dr. Zunan, welcome. Thank you. Great to have you here. It's great having you today. So I've known your name for a long time and I've read your column in the Honolulu Star Advertiser. And so I'm excited to meet and talk with you today. Likewise. That should be fun. So you are the director of a clinic. What is the name? Monacaio-Malama Integrative Health Care Group and Rehabilitation Center. Okay. And what does that mean? Well, the name of the clinic Monacaio-Malama, Malama means healing or caring. And Kai is the is the near ocean where the reef is as opposed to the Moana. And Moana is just energy, ki or chi or prana. So kind of the healing spirit of the ocean. Okay. And what is integrative health care? Integrative medicine is really about bringing together the best of modern medicine with traditional healing arts in a culturally sensitive whole patient approach. It's essentially a team-based collaborative care, as we said. At your clinic, what type of physicians and health care providers are there? Right. Well, we have a team of about 50. We've been in practice for almost 20 years. We've seen about half a million visits. And our departments, there's a medical department, medical providers, department for naturopathy, for chiropractic, for acupuncture, for massage therapy. We have several psychologists and a sleep lab. Okay. So it's kind of like when you talk about integrative care, are you talking about like combining different resources in order to give the best experience to the patient? It's really it's it's regular medicine, but it's a bigger tool set. So a lot of people come just with a cough or a cold or a flu or urinary tract infection. And it's regular medicine. Not everything is special or different. But there's a big team with a lot of resources and a lot of skill that works closely together for complicated problems or prevention and for optimal wellness. So if someone has a chronic condition, say chronic back pain or chronic neck pain, what can your clinic do for them? Well, the most important thing always is to make a good diagnosis. We don't want to be treating here and there for, you know, without a clear diagnosis and a clear plan. But say low back pain, for example, we want to make sure that we understand what's generating that low back pain and offer services that will be helpful. Often we'll provide physical therapy, acupuncture quite often, chiropractic, sometimes massage therapy. We also offer stem cell therapy and regenerative medicine that can be helpful for back pain, depending on the diagnosis. So if there's a psychological component, would that be where you have the psychologist? Sure. Our psychologist sometimes will simply be treating psychological issues related to depression or anxiety or ADHD, but also quite often there's a constellation of symptoms. For example, we treat a lot of vets that have physical ailments, psychological ailments like PTSD, and then they have medical issues as well, their heart, their lungs, their kidney. So our psychologists are very helpful in managing those aspects of health issues that require that kind of support. Okay. And so do you find that if someone has a prolonged period of treatment that it's a good idea to try something else or to at least look for a psychological component? Sure. I mean, you know, about 15 or 20 percent of the practice is chronic pain. And the truth is about chronic pain is that eventually almost everyone succumbs to depression. Chronic pain is such a drain on the system in so many ways in terms of what we can't do in terms of the pain itself, in terms of our function, our relationships that it's just so common for people to have what we call a reactive depression, secondary to chronic pain. What type of situations would you use tools like acupuncture or more eastern medicine that are not necessarily what other clinics might use in the US? Yeah. So acupuncture and also you could almost put naturopathy in that same question, naturopathic medicine. You know, acupuncture at Manukai is most often used for musculoskeletal issues, but the traditional Chinese medicine is as vast as conventional medicine in terms of the different kinds of things that you can treat, from fertility to insomnia to chronic fatigue. And I would say much the same about naturopathic medicine. Now, I noticed that in your experience that you have experience as an acupuncture physician as well as in Chinese medicine, how did you go, actually I should ask you, why did you seek that experience? Well, you know, I don't practice acupuncture myself these years. And, you know, we typically have three or four acupunctures in our department at any one time. But really the inspiration for me came way back in the 70s when I was a teenager and traveled over land to India and Nepal and met the Tibetans. And then later I integrated that into my undergraduate work, studying the role of the mind in the cause and course of illness according to the Tibetan tradition. So I began to run courses at the request of my teacher in Nepal or Westerners to learn Tibetan medicine. And eventually he took me to see the Dalai Lama, His Holiness the Dalai Lama, who asked a lot about that and really that conversation I had with him crystallized the work that we're doing today. And how important is a patient's mind in terms of addressing their physical complaints? You know, a lot of times we think about the mind and body as separate but they really aren't. They're sort of two facets of the same thing. So, you know, we've entitled this show mind and body as one. The mind is just critical to understand our relationship to our illness, to understand our perspectives and, you know, when it comes to sports, for example, to understand how to focus, how to motivate and know when it's time to stop before we do internal violence. Okay. One time when I was training for a triathlon, I had low back pain and I didn't have any serious diagnosis, no herniated disc or bulging disc. I knew it was more of a degenerative disc disease issue or just a musculoskeletal issue. And rather than just stay home and sit on the couch with my low back pain, I went and ran really hard in a training workout and it actually took my back pain away. Is that an example of mind over body or how would you address that? Well, I think, you know, that's something that happens often enough that we're stiff, we're tired, we feel defeated, and our back hurts and we stay on the couch. But we get up, we get moving, we get the blood moving, we move through it. And that kind of psychological motivation is helpful. But not all the time. There are those times where we think that we can just overpower our bodies and it will tell us that we can. And one of the signals that we're getting that there's something wrong is pain, right? Sure. But, you know, the interesting thing about pain when it comes to musculoskeletal issues or muscles or bones or sinews is usually we can trust how we feel. And not worry as much about the MRI or the X-ray, which is different, right? Very different than if we have high blood pressure or diabetes or cancer. It doesn't really matter how we feel. We need to take care of it. Those are silent killers. Okay. So is it, I've heard that our bodies love movement. And would that be true with regard to someone's complaints of pain? Sure. I mean, but again, it depends. You know, patients who know a helicopter pilot who came down and crashed over Panama, you know, while serving in the military. And, you know, he's very broken. I've had patients, you know, in multiple motorcycle accidents. So there are people that have real pain, real bad pain for real good reasons. But generally, you know, through evolution, we didn't sit and look at computer screens. Through evolution, we ran, we hunted, we gathered, we were on the move all the time. And that's what the body loves. Right. And of course, a lot of us spend a lot of time looking at the screens or sitting on our couches and working at a computer and sitting down all day. And so, certainly, that's a problem. Is that correct? It's a big problem. I mean, it's really, it affects the mind and the body, how we think, how we relate to the world. And, you know, our bodies are not made to sit still all the time. Okay. Okay. We're taking a short break. I'm Catherine Norr. This is much more on medicine on the Think Tech Live Streaming series. And we'll be right back to talk with Dr. Zunen. Hi, I am Yukari Kunisue, host of Konnichiwa, Hawaii, Think Tech Hawaii's Japanese program, broadcasting every Monday from 2 p.m. I usually invite a guest in Japanese language community. That's interesting things. And I'd like to share stories with you guys. Please turn in and listen to Konnichiwa, Hawaii. Aloha. This is Rob Hack. My show is exporting from Hawaii every other Thursday from 12 to 12.30 p.m., where I bring in people involved in the entire exporting infrastructure in Hawaii, including government, academia, and manufacturers and shippers themselves. Please join me every other Thursday, 12 to 12.30 p.m., and exporting from Hawaii. Mahalo. We're back. We're live. I'm Catherine Norr. And this is much more on medicine on the Think Tech Live Streaming Network series. And we're talking with Dr. Ira Zunen about the mind and body as one, bringing together the best of modern medicine and traditional healing arts. Dr., does your integrative approach help for preventive medicine? Sure. I'm board certified in preventive medicine. And really where we want to start is a healthy lifestyle, a healthy approach to taking care of our bodies to prevent illness. And then the next step is to be screening for those things that we know inevitably happen to people over time. And the third part of prevention is once something has happened, once there's been a health event, how do we do our best to restore health? So I could see a benefit in having all of these approaches together in one clinic, because if a patient says something to their massage therapist or physical therapist that they felt that should be brought to the attention of their physician, that that could be a benefit to address those preventive or preventive and other issues. Is that correct? Sure. There's so much benefit in a team-based collaborative approach where we're all talking to each other. I can't tell you how many cases of depression, for example, we're tipped off to the medical providers by our physical therapist or occupational therapist. For patients having a 15-minute visit with a medical provider, there's the blood pressures, diabetes, there's the mental health, there's the work note, there's all of these things, and they're covering a lot of ground. But when they spend one hour with the physical therapist, exercising, there's a lot of chat. And we've had so many cases picked up. Doc, I think you better take a look at this person. I think they're depressed. Sure. And that makes a whole lot of sense, because I think that where providers are focusing on manual or passive therapy or even active therapy, there's a lot more like chat. So that makes a lot of sense. So there's a lot of weekend warriors out there, a lot of athletes out there who are trying to make their bodies as optimal for performance as possible. Does your clinic have a role in doing that? Sure, absolutely we do. And we spend a lot of time on that. I'd say the most important thing for a weekend warrior is when you first decide to become one after having been quite sedentary and not really managing health or diet and picked up a few pounds. It's important to get checked out to be sure that there's nothing that would make sudden, you know, cardio dangerous. It's important to ease into it. And one of the really big aspects of being successful is to pick something that's fun, doable, and works in your schedule. Okay. Lots of people make big, ambitious decisions that I'm going to do this, but without bearing those things in mind, they don't last. Well, you know, that's interesting you say that because about a year and two months ago, I decided I would start going to 24 hour fitness classes and just dove in and I wrote on my calendar and X for every class I did and I did 200 classes for the year and then very successfully enjoyed it and focused on combat, body combat and then really started loving Zumba. And so this year now I'm adding an extra class and now I'm doing doubles. But it was interesting because last night another person in my class that did a double did combat and then did Zumba, she mentioned that she was having sciatica. And so off camera, we were talking about how sometimes you need to adjust the way your body is when you do kicks or whatever. Can you comment on that? Because it seems to me that athletes and weekend warriors could benefit from learning kind of how their body should be when they do certain activities. Right. I mean, I think what you're talking about is generally under the rubric of what we call mechanics and kinetics. So the abdomen is like the computer. I've been doing martial arts for many years. The abdomen is sort of like our computer. It's how we communicate between our legs and our chest and our arms, our pelvis, you know, pelvis to our torso. And so that's, you know, a lot of people are dialed in the core strengthening. But even that sciatica we talked about if the feet are out this way when you're doing something, there's a lot more pressure on those little muscles on the side of your butt. If you bring the toes in a little bit, it unloads those muscles and puts them on the big strong thigh muscles to prevent sciatica. So that's a very important distinction in body mechanics that you wouldn't know unless you talk to an expert. Is that right? Well, our physical therapists work quite a bit with that. Our chiropractor would be dialed in and a number of our medical providers. We try to help out. And you know, the key is to really meet people where they are. So sometimes we have somebody sedentary, gained a few pounds and eating a lot of fast food. Sometimes we have very, you know, very high-end athletes that are looking to get a little more performance out of their system. I see. And let's bring up the Taekwondo picture. So is this you? That's me. Okay. And is that your son? I think. That's my son, Brandon. Okay, fantastic. And it looks like you have a black belt. Yes. I've been training for quite a few years. Okay. And so how many years have you been doing? This is my 44th year training. Fantastic. So what type of, what do you have to do in order to be in shape for 44 years to perform in Taekwondo at that level? Well, I think, you know, for any type of rigorous, you know, kind of high-performance athletic activity, you need to have a combination that's a triad of strength, of flexibility, and of cardio. And usually Americans focus on strength and cardio and forget about the flexibility training. Right. So I've been doing yoga as long as I've been doing Taekwondo. And that's been critical to maintain flexibility. But that's really, that's really the three legs to the stool. Okay, let's pull up the yoga picture. Okay. And again, you and your son, wow, it looks like you can bend very far. You look very flexible in that picture. How long have you been practicing yoga? Actually, you know, when I first went to India as a teenager, so this is 44 years ago, the same year I took up martial arts, yoga, and meditation. And I managed to continue to practice those three, those three arts since then. And so that would also be a good 44 years ago. Do you think that integrating yoga and meditation in one's healthcare regime would help someone either improve their condition or prevent problems? Well, absolutely. I mean, one of the big, from the standpoint of yoga, one of the things that happens is our healthcare system is able to keep our heart and lungs and kidneys and so on going longer and longer and longer. And if we don't have the flexibility, what we find is we get very old. We have good longevity, but we're living in jail. Our bodies are stiff, and we don't have the flexibility. We don't have the mobility. We have pain. And it's kind of like, well, I've made it all these years, but I'm kind of imprisoned. Yoga can prevent that. Okay. So yoga is freedom if someone practices it regularly and gains that flexibility, right? Absolutely. I mean, I wrote a book called The Practice of Freedom. And to me, freedom, the practice of freedom is really that practice of yoga and meditation. And for me, personally, the martial art. Okay. And so let's bring up the next picture of the diving. Okay. And so is that you? That's me. Actually, that picture, I think, was published in National Geographic. That's a group of dive on the Great Bear Reef as part of the worldwide voyage on Hokulea and Hiki Analia. Okay. And so I snorkeled at the Great Bear Reef. And that was a neat experience. I can't even imagine going farther down and being able to actually see more fish, because we didn't see that many fish from up so high. What kind of health does one have to have in order to accomplish that? To scuba dive. Oh, well, to scuba dive, you have to have healthy ears, a good sense of balance, the ability to control the breath, and then generally decent health. I mean, when you're underwater, even though it's only 20 or 40 or 120 feet, it's kind of like being in outer space. So there needs to be a certain amount of body control, body awareness, and the reasonable health. Okay. And let's move to the Hokulea photo. Tell us about this picture. That picture is also part of the worldwide voyage. That's also with my son, Brandon, my younger son. And we are sailing there along the Great Bear Reef through the Torres Straits under Papua to Darwin. Oh, that's interesting. Did you have a medical capacity on that voyage? Yeah, on the longest voyages, there's usually 11 crew and there's 33, 34 Kuliana. And one of mine was the medical officer. I had the opportunity to do the Great Bear Reef, also sailed from Cape Town to Brazil, across the Atlantic, and from New Zealand to Tahiti. And what are the concerns that you have to address as a medical officer on that voyage? Well, it can be anything. And the closest thing to compare it to is really what we would call wilderness medicine. It's not emergency medicine because the ambulance isn't going to be there in 20 minutes. So it ranges from seasickness, mental health issues to heart issues to trauma. We steer with a sweep, almost a 20 foot hoy. And that is extremely strenuous. So there's a lot of muscular scales of stuff. Number one, the sickness. Oh, okay. I would imagine that. It's been very interesting today talking with you about what an immigrant grade of medicine approach is and about your clinic and about some of the things that you're able to do, doctor, as an athlete and as a medical officer on the Hokulea. And I think we've learned a lot about how we need to maintain our activity and to maintain flexibility as well as strength and cardio in our activities. So we're about out of time, and we'll have to wrap it up. This is Catherine Norr. This is much more on medicine on the ThinkTech live streaming network series. We've been talking with Dr. Ira Zunin about the mind and body as one, bringing together the best of modern medicine and traditional healing arts. Thank you for joining us today, and thanks for our broadcast engineer, our floor manager, and to Jay Fidel, our executive producer who puts it all together. Please join us for future ThinkTech productions. Aloha.