Transcription:

Bill Klaproth:  This is the Oasis Rheumatology podcast featuring Dr. George Muñoz, Head of the Oasis Institute and Chief of Integrative Medicine and Integrative Rheumatology for the American Arthritis and Rheumatology Associates.

Dr. Muñoz, it is great to talk with you. So let's start out by learning a little bit more about you. Can you give us some brief background on your education, your work and your interests?

Dr. George Muñoz: Sure, Bill. I came from New York city. I'm a New Yorker. I attended Columbia College and Mount Sinai School of Medicine, which is now called the Icahn School of Medicine in New York and did my internship and residency at the Mount Sinai Hospital in New York City and subsequently for my fellowship training in rheumatology, went to Boston and trained at the Harvard Affiliates, the Brigham and Women's Hospital and the Beth Israel Hospitals in Boston. In 1985, I then moved to the great city of Miami, the magic city of Miami. And I've been in the North end of town, working in clinical practice since 1985.

Bill Klaproth: And then how about your interests, Dr. Muñoz?

Dr. George Muñoz: So I have a lot of interests. Many of them are related to sports, to training, trekking in remote areas of the world. I'm interested in indigenous cultures, in medical anthropology. I have, uh, a lot of family time. We love animals. Right now, we have three dogs in the house and I've had my older children and now my late teens that are still in the household. And so taking care of them, the family, my wife, and all the responsibilities that go with that pretty much keeps me busy. I like to train, I like to work out and take care of the physical part and do some meditation and some contemplative activities to help the mind, the body and the spirit.

Bill Klaproth: Well, it sounds like you have a full and active life.

Dr. George Muñoz: I certainly do. I'd like my patients do the same.

Bill Klaproth: Absolutely. So speaking of that, Dr. Muñoz, what is your mission and your goal? What is your message that you want us to know?

Dr. George Muñoz: I think one of the prime messages that I want to convey, not just in this podcast, but when anybody has contact with us in the clinic or interacts with us in seminars is really that I'm looking to be able to approach health and wellness from a whole body concept, not just the physical and not just about medications and drugs, but really the whole person. One's activities, one's sleep, one's spiritual mind state, the kind of food that we eat, vitamin supplements and how we take care of not just our physical body, but our minds, and be able to regenerate and maintain a nice balanced state that is really where health and wellbeing stems from.

Bill Klaproth: And do you think more communities are learning that message on their own or realizing that message?

Dr. George Muñoz: I do believe that, I see that, but yet I think it's not enough. I think that more has to be done in that regard. And that is one of the prime activities and purposes that we at our care center strive to model for our patients, my wonderful staff and really to take it back home to our families and continue that process on and on.

So this is an ongoing lifestyle. There's no really start or ending other than perhaps times that create crisis that make us look at what we need to do. And what I'd like to convey is, is why wait for a crisis? Let's start now.

Bill Klaproth: So when it comes to that mindset of why wait for a crisis, let's start now, is that where integrative medicine/rheumatology fits in from the medicine side?

Dr. George Muñoz: Thanks for putting it in that perspective. Yes. Specifically looking at health or dis-ease as opposed to disease, the issues that many times are manifested in the body are not only psychologic, but involved in our nutrition, our sleep, quality of life or lack of it that manifest in our energetics, affect our immune system, and subsequently can wind up becoming for some people, for example, an autoimmune disease like rheumatoid arthritis.

If the genetics especially are predisposed, not taking care of ourselves in all these different areas may trigger the disease in the person who is more susceptible. So in my field of rheumatology, which traditionally has been autoimmune disease, degenerative disease, dealing with many times abstract concepts because of the science has been blistering over time, trying to develop the scientific paradigms with which to address the conditions and give practitioners and physicians some type of matrix on how to help their patients, developing primarily drug approaches, we're now saying that while conventional therapies, conventional medicine, conventional rheumatology has fantastic treatments, why not also approach a person's condition, their medical condition, from the whole body approach, the whole person approach, not just the standard pharmacologic approach, which is highly important. And for which, I'm so grateful that we have phenomenal treatments now, because when I started practice in 1985, my waiting room was full of wheelchairs. And now in 2020, we rarely have a wheelchair primarily due to the phenomenal advances in advanced biologic therapies for all these conditions, for rheumatoid arthritis, for lupus, for arthritis with psoriasis, for ankylosing spondylitis, for all the immune-mediated inflammatory conditions.

But if I ignore my patient's sadness, my patient's mood, my patient's inability to sleep well, my patient's inability for whatever reason to have food security, for my patient's yearning for dietary nutritional or exercise constructs that makes sense to them that they can understand, that they can be taught and absorb. If I don't do those things, then I'm only partially treating them. So the integrative approach is using all the modalities that make sense that combine with our conventional therapies to create the best outcomes for our patients.

Bill Klaproth: So, Dr. Muñoz, when you talk about the whole person approach, is that how integrative medicine differentiates from conventional medicine?

Dr. George Muñoz: That is exactly how it differentiates. We are not a specific organ or a specific disease. We are whole individuals comprised of mind, body, spirit, the physiology, the anatomy, the energetics, the feelings, the immune system, all the organ systems along with that vital life force is what comprises human beings in all life forms. Therefore, if we simply address one area without addressing it all, the job is incomplete. And the thought of having an abyss, a separation between integrative approaches and a purely scientific or singular deductive pharmacologic approach to treatment is actually false in the sense that together they work best, separately they work less efficiently. And in the end, we can have a situation where an operation is a success, but the patient is unhappy or still has valid medical issues that weren't addressed.

In spite of the phenomenal technology that we have in cure and advanced biologic therapies, we still need to address these domains of mental health, of psychosocial importance of sleep, of food security, of proper nutrition, proper use of nutraceuticals and supplements and teach our patients and individuals, how to exercise for them, the concept of having an exercise prescription as important as a prescription for a medication needs to be understood and accepted by practitioners and patients alike.

The integrative approach flows right into conventional medicine. I don't see a direct border, a big wall. I see it flowing and going back and forth and working together.

Bill Klaproth: Yeah, that is really interesting. I love what you're talking about. And when you talk about healing the whole person, you talk about sleep and nutrition and exercise and feelings and life force, which also really directly affects a person's physical wellbeing as well. Is that correct?

Dr. George Muñoz: That is absolutely correct. And we have phenomenal information now about consciousness, about the benefits of meditation, the quality of sleep, all effecting the immune system, its ability to protect us from foreign invasion, from infection, viruses like COVID as well as the immune system surveying and protecting the body from cancer, degenerative changes that can occur.

We're constantly fighting that situation within our bodies and the better we're balanced in mind, body, spirit, the better our immune system is able to function and take care of the domains that are important for total health.

Bill Klaproth: That's why this integrative medicine approach is so important. So what inspired you and how did you get involved in integrative medicine?

Dr. George Muñoz: So that's a great question, because it takes me back to my early childhood and my mom worked and my dad was away and for a while, they were actually split up. So I grew up with a grandma at home and she had her medicinal ways from her homeland, from the Andes, from Quito, Ecuador. And she would share those with me growing up. I learned about home medicinal remedies and never really thought that much about it. But as I went through medical school and then training, I then began to get questions from my patients regarding this very topic. And I noticed that many people had similar experiences from their backgrounds, from their upbringings, from their relatives and grandparents.

Patients asking me questions repeatedly about natural approaches prompted me to look up and do research, because I never got that training in conventional medical school or residency. And I was at top programs really in the US and perhaps even the world. What happened was by being asked these questions over and over again, over time, I began to realize that there's something to this. I also realized that my patients were using natural remedies, even when they weren't always admitting it to me upfront until they developed a trust and it was important for me not to pooh-pooh them, but to collaborate with them, work with them. And then I had to learn how to work with these supplements and herbs and natural approaches. And I realized how little I knew about diet and nutrition.

And ultimately, the more I read, the more I realized I didn't know. And I was inspired by some amazing people, including Andrew Weil, Alberto Villoldo and John Perkins. When I went to a seminar on a weekend in Fort Lauderdale and I met all three of those individuals and I wound up training with each of them over the next 15 to 20 years, but that day I did not realize that that's where my life was going to take me. So I trained in integrative medicine with Andrew Weil. I became a fellow. I became one of the first rheumatology fellows in the United States. I was honored to be handpicked to do that.

I also trained with my shamonic mentors of whom Alberto Villoldo and John Perkins were two individuals and another shaman who was my main teacher and mentor who recommended that I do this workshop, a Dawn Eagle woman from Wyoming, who I had the privilege of meeting and doing personal growth work that blew my socks off.

And then I realized the didactic scientific way, which I believed in, which I was immersed in, was not the only way. That there was an unseen world of energy, of healing, of tradition, under the guise that we call medical anthropology. I began to study that and I studied all of that longer than I was in conventional medicine training for over 10 to 15 years.

So my journey has been one to really analyze, discover and rekindle, I think, what is within all of us, which is the natural ability to heal and to incorporate best practices in the realm of mind, body, spirit, along with the best that conventional medicine in the West has to offer in terms of modern medicine and modern technologies.

Bill Klaproth: That is quite a story and background. When you go to see the doctor, not often do you hear someone that has trained and studied with a shaman. So this is really fascinating, your involvement and your education in integrative medicine. So let me ask you this, who is AARA, which is A-A-R-A? Who is AARA and Bendcare?

Dr. George Muñoz: This is another amazing story, I think. AARA stands for American Arthritis and Rheumatology Associates. And this is a rheumatology supergroup that I am privileged and humbled to be one of its founding members five years ago, along with other rheumatology colleagues of mine here in South Florida.

Basically, we got together trying to preserve our specialty, improve the care of our patients, because many times in the modern medical model, what physicians want to do and recommend as far as treatment, that control is being degraded and lost and payers and insurance companies and other intermediaries have interfaced themselves in between the relationship of the physician and the patient to many times block a treatment that we think is necessary for a patient. and sometimes it's due to under the guise of medical necessity, but many times it has to do with money and payments and trying to reduce costs.

What's happened is, is that rheumatology specifically, since we have patients in chronic pain, they're chronic patients, they require ongoing care and they require, as I've said, sometimes these advanced biologic therapies, which can be quite costly, but if we're able to treat people aggressively quickly, not delay, improve their quality of outcome, we can actually save money on the backend by preventing unnecessary surgeries, unnecessary hospitalizations, unnecessary complications, and improve quality of life, QOL as we call it, improve the overall outcomes, so that there is a value based improvement, and this is where integrative rheumatology and AARA come into play.

So we have now the largest rheumatology group of patients in the world that we take care of. We have a tremendous database and we're able to look at the data to do assisting with artificial intelligence, to help our physicians make the best choices for their patients using phenomenal modeling so that we can reduce the unnecessary cost of treatments that aren't as good or don't have the best effect and the best outcome, and we can use predictive modeling to determine who's going to do best with certain protocols. And if we add the whole body approach that we've been talking about, this integrative approach, our outcome really improved and we're able to reduce unnecessary costs and improve the value of care.

So this is the goal of AARA, but how do we do it? We're physicians. We're not data scientists. We are not business people. We are not contract experts. We don't know how to take care of our purchasing needs for a large group. So what did we do? We formed a separate company called Bendcare to bend the angle of care, it's a play on words, and Bendcare are our business partners that help us do everything compliantly.

So our motto is AARA powered by Bendcare, to improve rheumatology outcomes into the future and to define what best practices in rheumatology will be, should be, and to become really the preferred destination for rheumatologic care into the 2021 time zone and beyond.

Bill Klaproth: AARA powered by Bendcare. That's interesting. And I love how you put this in terms of how there is a cost benefit to this with this smart, targeted integrative approach and how you're able to save money on the backend with this approach, calling it value-based improvement. So this really sounds great.

Is this why AARA was formed? And is that its purpose/drive?

Dr. George Muñoz: Yes and yes. I've been told I'm a direct communicator.

Bill Klaproth: And that's what people want. They want that direct communication. Well, Dr. Muñoz, this has been great. It's been wonderful getting to know you a little bit better and learn about your background, your mission, your message, and certainly the difference between integrative medicine and conventional medicine and all the benefits of integrative medicine. Dr. Muñoz, thank you so much.

Dr. George Muñoz: Thank you, Bill.

Bill Klaproth: And this is the Oasis Rheumatology podcast featuring Dr. George Muñoz. For more information, please visit the OasisInstitute.com. Thanks for listening.