Atherosclerosis

Atherosclerosis a common cause of diseases and deaths, and what we can do for prevention and treatment

Atherosclerosis is a pathologic process that causes disease of the coronary, cerebral, and peripheral arteries (cardiovascular disease, CVD). They are many causes for the development of this pathologic process that affects so many of us. Diseases like diabetes, hypertension, elevated cholesterol and chronic kidney disease are major important risk factors that contribute to the development of atherosclerosis. Also the some of our life style that also play a significant role: smoking, obesity, sedentary life, and stress and conflicts in our life.

At Bandera Family Health Care, diseases that contribute to arthrosclerosis and cardiovascular conditions itself, account for fifty percent of the patients we see. It is also a major factor in diseases requiring hospital admissions and transfers to emergency rooms. An unfortunately, together with cancer is the leading cause for death on our patients. Because of the prevalence of these diseases in our patient population is that we are committed for the first quarter of 2013 to learn and disseminated information about atherosclerosis and the dire consequences of it to our health and wellness.

 Atherosclerosis begins in childhood with the development of fatty streaks. These advanced lesions of atherosclerosis occur with increasing frequency along with aging. Nonetheless, they can be seen at any age and initially are very subtle. They can be seen on routine chest x-ray as calcifications in an aorta or coronary arteries. It can be seen as an enlarge heart or a fatty liver. The presence of protein or albumin in the urine is also an early indicator of inflammation of the arteries. For others having sugars higher than 100 is also a very early indicator.  Sugar that doesn’t get use as fuels is stored as fat and it is this free floating fat that goes to action by damaging our arteries. Our waist line is another good indication of it.  For men a measurement of 40 inches and 35 for woman is a factor on the initiation and progression of these deadly diseases.

Cardiovascular disease (CVD) is common in the general population affecting the majority of adults past the age of 60 years. In 2012, CVD was estimated to result in 17.3 million deaths worldwide on an annual basis. While CVD remains the leading cause of death in most developed countries, with approximately one million Americans annually dying from CVD, mortality from acute MI appears to have decreased by as much as 50 percent in the 1990s and 2000s. The prevalence of CVD is rapidly increasing in developing countries as well.

In an autopsy study of 2,876 men and women aged 15 to 34 years who died of external causes, all individuals had aortic fatty streaks.

As a diagnostic category, CVD includes four major areas:

• Coronary heart disease (CHD), manifested by myocardial infarction (MI), angina pectoris, heart failure, and coronary death.
• Cerebrovascular disease, manifested by stroke and transient ischemic attack.
• Peripheral artery disease, manifested by intermittent claudication.
• Aortic atherosclerosis and thoracic or abdominal aortic aneurysm.

In the United States, coronary heart disease is the leading cause of death in adults accounting for about one-third of all deaths in subjects over age 35.The 2010 Heart Disease and Stroke Statistics update of the American Heart Association reported that the 2006 overall death rate from cardiovascular disease was 262.5 per 100,000.

Multiple factors contribute to the pathogenesis of atherosclerosis, including endothelial dysfunction, dyslipidemia, inflammatory, immunologic factors, plaque rupture, and smoking

Many risk factors for cardiovascular disease are modifiable by specific preventive measures. In the worldwide INTERHEART study of patients from 52 countries, nine potentially modifiable factors accounted for over 90 percent of the population-attributable risk of a first MI: smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, daily consumption of fruits and vegetables, regular alcohol consumption, and regular physical activity.

CHD RISK EQUIVALENTS: Some patients without known coronary heart disease (CHD) have a risk of subsequent cardiovascular events that is equivalent to that of patients with established CHD. All patients with a CHD risk equivalent should be managed as aggressively as those with prior CHD.

NONCORONARY ATHEROSCLEROTIC DISEASE: Non-coronary atherosclerotic arterial disease includes patients with carotid artery disease, peripheral artery disease, or abdominal aortic aneurysm. Patients with any form of non-coronary atherosclerotic arterial disease have a 10-year risk of developing CHD that exceeds 20 percent. Concurrent risk factors should be treated aggressively in such patients.

DIABETES MELLITUS: Insulin resistance, hyperinsulinemia, and elevated blood glucose are associated with atherosclerotic cardiovascular disease.  In the INTERHEART study, diabetes accounted for 10 percent of the population-attributable risk of a first myocardial infarction (MI).  The all-cause mortality risk associated with diabetes has been compared to the all-cause mortality risk associated with a prior MI. While the causes of death are not equally frequent in these groups (CVD death is more frequent after MI, while non-CVD death is more frequent in patients with diabetes), the 2002 National Cholesterol Education Program Report designated diabetes a CHD risk equivalent, thereby elevating it to the highest risk category. Although a recent publish study found that having DM is equivalent to having heart disease, as we initially thought.

In addition to the importance of diabetes as a risk factor, diabetics have a greater burden of other atherogenic risk factors than non-diabetics, including hypertension, obesity, increased total-to-HDL-cholesterol ratio, hypertriglyceridemia, and elevated plasma fibrinogen. The CHD risk in diabetics varies widely with the intensity of these risk factors.

Guidelines published by the National Cholesterol Education Program and the sixth Joint National Committee have provided a framework to treat coronary risk factors aggressively in diabetics.

There is compelling evidence of the value of aggressive therapy of serum cholesterol and hypertension in patients with diabetes. In our practice we make a great effort on controlling the three major diseases. We start by creating a physician patient collaborating agreement for the management of these conditions. We make patients aware of the laboratory results and the importance of their vital signs. We called them “The ABCs of Diabetes”. For example: “A” for Hemoglobin A1C, “B” for Blood Pressure and “C” for LDL- cholesterol. Every patient needs to know there ABCs and failure to control these three elements would result in the loss of sight, a limb, or heart attacks, strokes and kidney failure.

HYPERGLYCEMIA WITHOUT OVERT DIABETES MELLITUS: There is good evidence from observational studies that higher levels of blood glucose and glycated hemoglobin correlate with cardiovascular risk in patients with and without diabetes (DM) at baseline. Sugars higher than 100 on fasting state are as stated before a risk for patients. Providers and patient then to minimize this issue but this is not a good practice. Remember, this is a sign that we are consuming more calories and carbohydrates than we should. This will eventually lead to diabetes and subsequently could lead to CVD. It is important to reduce these values as soon as the high goal is less than 100 sugar value in fasting and not higher than 140 after eating. The earlier we do this the better and easier it gets. At the beginning, a lifestyle change that includes a reduction of 10 percent of weight is enough to bring sugars back to normal and stop the progression of DM. By the time we get diagnosis with DM, we already have lost fifty percent of the function of the pancreas and the use of drugs for treatment is then imperative. So the message is, don’t be fooled by a little of high sugar because you will pay the price later.

CHRONIC KIDNEY DISEASE: The increased CHD risk in patients with end-stage renal disease has been well described, but there is now clear evidence that mild to moderate renal dysfunction is also associated with a substantial increase in CHD risk. Practice guidelines from the National Kidney Foundation in 2002 and the American College of Cardiology/American Heart Association task force in 2004 recommended that chronic kidney disease be considered a CHD risk equivalent. The data supporting this conclusion are presented elsewhere

The presence of established risk factors is associated with CHD, and the achievement and maintenance of good health is being emphasized in programs from The American Heart Association that promote seven ideal cardiovascular health metrics, including:

• Not smoking
• Being physically active
• Having a normal blood pressure
• Having a normal blood glucose level
• Having a normal total cholesterol level
• Being normal weight
• Eating a healthy diet

Family history is an independent risk factor for CHD, particularly among younger individuals with a family history of premature disease. The definition of what constitutes a family history of premature atherosclerosis has been somewhat variable in different studies. However, there is a general agreement that a myocardial infarction (MI) or death from CHD in a first degree relative (i.e., parent or sibling) prior to age 50 (males) or 60 (females) denotes a significant family history.

Cigarette smoking is an important and reversible risk factor for CHD. The incidence of a myocardial infarction (MI) is increased six fold in women and threefold in men who smoke at least 20 cigarettes per day compared with subjects who never smoked

Diets with a high glycemic index (GI) or glycemic load (GL) may contribute to the risk of CHD

There is growing evidence suggesting that fruit and vegetable consumption is inversely related to the risk of CHD and stroke.

Exercise of even moderate degree has a protective effect against coronary heart disease and all-cause mortality. Exercise may have a variety of beneficial effects including an elevation in serum HDL-cholesterol, a reduction in blood pressure, less insulin resistance, and weight loss

Obesity as measured by body mass index (BMI) significantly and independently predicted the occurrence of CHD and cerebrovascular disease after adjusting for traditional risk factors.

Psychosocial factors may contribute to the early development of atherosclerosis as well as to the acute precipitation of myocardial infarction and sudden cardiac death. The link between psychological stress and atherosclerosis may be both direct, via damage of the endothelium, and indirect, via aggravation of traditional risk factors such as smoking, hypertension, and lipid metabolism. Depression, anger, stress, and other factors have been correlated with cardiovascular outcomes

SUMMARY

• Cardiovascular disease (CVD) is the leading cause of death in most developed countries, with a prevalence that is rapidly increasing in developing countries as well. Many risk factors for cardiovascular disease are modifiable by specific preventive measures, therein offering an opportunity to reduce the burden of CVD worldwide.
• Some patients without known coronary heart disease (CHD) have a risk of subsequent cardiovascular events that is equivalent to that of patients with established coronary disease. Examples of such high-risk patients include patients with noncoronary atherosclerotic arterial disease, diabetes mellitus, and chronic kidney disease. All patients with a CHD risk equivalent should be managed as aggressively as those with prior CHD.
• Family history is a significant independent risk factor for CHD, particularly among younger individuals with a family history of premature disease.
• Hypertension and dyslipidemia are well established risk factors for CVD. Effectively treating both hypertension and dyslipidemia can significantly reduce the risk of future CVD events.
• A variety of lifestyle factors, including cigarette smoking, diet, exercise, alcohol intake, and obesity, significantly impact the risk of developing CVD.

At Bandera Family Healthcare we are committed to provide the best quality care to our patients to reduce the risk of CVD disease and the impact that it has on our patients and their families. We also recognize that the treatment of heart attacks, strokes and amputations is major burden to our patients and dramatically increase the cost of health care. As a result, we have created a Quality Initiative for the first quarter of 2013. This initiative will encompass the following:

• Provides education and seminars. We will have monthly continued medical educations for all physicians, nurse practitioners and physician assistant. The first one was held on January 24^th, 2013 Sponsor by Cardiovascular Consultants, Dr Jorge Alvarez and Methodist Hospital.
• We have two more seminars on cutting new technologies: Health Diagnostic Laboratory with advance lipid testing and Carotid Measurement Intimae Thickness (CMIT).This are to be held February 28^th, 2013.
• Develop and implement training programs and competency testing for our nursing staff.
• Develop and implement a Health and Wellness program for our staff and eventually over to our patients and their families. About 70% of our staff members showed an interest and commitment to our program that was launched in December 2012. With the leadership and expertise of Laura Norris with FITopia TX, we are implementing the program. She is an outstanding fitness and wellness instructor. She has activated many of our start-to-start exercising and is helping them with a weight monitor program. She has created a rewards program for the biggest weight loser and runner-up. The winner is rewarded $500, $200 and $75 respectively.
•  We have hired two nurse educators that come to our office 3 hours every day to educate our patients. They will also help with the nurse education program and competency testing.
•  We have upgraded our stress testing equipment and develop protocols for stress echocardiography and dobutamine stress echocardiography.
•  We are in the process of creating transfer agreements with hospitals for the timely transfers of ST elevation acute myocardial infarctions (STEMIS) and acute stokes.
•  We have created a Provider and Practice Report Card. These we allow us to see how well each provider is doing in regard to the standard of cardiovascular care. Will also let us compare how well we do in compare to other practices.

As you can in Bandera Family Health Care we are committed to provide the best quality care. We believe in the power of knowledge and how this empowers and motivates people to change. In an ongoing ABC study being conducted by our medical school in SA, it was shown that sixty five percent of our patients are at goal with ABC care. This is astonishing fact when only seven of them are at goal in our nation.

I am very proud of the accomplishment of our organization and much we have improved on the delivery of care to our community. I am very grateful to each staff member for their dedication and contributions to the practice success. But most important I am deeply grateful and honor to the patients that have entrusted their health and wellness to our organization.

Best wishes,

Ramon G, Reyes MD

Choquequirao Trip - Day 4

I woke up quite early, despite the short hours of sleep; I woke rested and full of energy. It was a very cold, fresh and chilly morning but very invigorating.

We were awakened by our crew with a cup hot mate tea. We had our breakfast served hot and healthy. We waited no time for it. It was as good as the prior dinner, healthy and tasty.  As soon as we were done we went to pack our belongings and soon thereafter we were ready for our second day of hiking.  We stated around 6:00 am. My bell from Turkey announced the beginning of the trek to the group. (Trek or Trekking is a long journey undertaken on foot in areas where common means of transport is generally not available). The ringing of the bell connected and grounded me, what a great beginning.  For my second day I packed lighter and left some of my excess stuff for the mules and our horseman to carry. Hugo the leader of this group was so helpful taking care of all us and making this second day a stress free one.

 

I remember the joy I felt at the start of this second day. The morning was so fresh, the nature was so welcoming and the breeze was chilly but relaxing. I was proud and ready for the trails which were as beautiful as the first day but a little easier since we were going down to meet the roaring river of Apurimac.

 

The Apurímac River (Spanish: Río Apurímac, pronounced [apuˈɾimak]) ("apu"=divinity "rimac"=oracle, talker) rises from glacial meltwater of the ridge of Nevado Mismi, a 5,597-meter high mountain in the Arequipa Province in southern Peru. The Apurímac is the source of the world's largest river system, the Amazon River. It rises in Peru's south-western cordilleras, 10 km (7 miles) from the village of Caylloma, and less than 160 km (100 miles) from the Pacific coast. It flows generally northwest past Cuzco in narrow gorges of up to 3,000 m, twice as deep as the Grand Canyon in the USA, its course interrupted by falls and rapids. Of the six attempts so far to travel the Apurímac in its full length, only two have been successful.

Can you imagine us hiking down this majestic and impressive view? No wonder my energy and disposition.  We made it to the campsite by the river by early morning. The beauty of this river was like nothing I have ever seen before. The sound of the passing river was surrounding every cell of body, it made it vibrate like lightning.

 The name of this bridge is The Choquequirao Bridge. It is the natural division between the departments of Apurimac and Cusco. This also marked the beginning of the most difficult and grueling hike of the trip. It started from 1550 meters at the bridge to 2500 meters at our new campsite. It took three to four hours of constantly going up with a very hard and slow walk. At one moment I felt like a snail climbing to the top of th Andes. I was so tired that my ancestors came and visited me and gave me extra motivation to continue in the journey. I knew that Condors could make it to the top of the Andes in no time.  They will then fly from peak to peak moving their wings in a majestic way.  Nonetheless, I was determined to make it.  I will take four or five steps and rest. I had no more energy left and when I would look up to the sky to ask for assistance, there it was, a Majestic Condor flying over us like saying I also welcome you to the “Cuna de Oro” the Golden Crater of the mountain site of Choquequirao.

Carlos and Rooney were highly impressive by this showing since Condors are rarely seeing flying over the mountains.  They both recognized the blessing and spiritual significance of it. I, on the other hand, felt the calling to finish this part of the trail even if it was with the help of Apache, our horse. Rooney gracefully offer me the horse which I took humbly to the top of the campsite.

We can all make it to the top of the hills, some fly like the condor, some jump like the rabbits, so run like the pumas and some drag and crawl like a snail and me. But we can all make to the mountaintop.

I felt blessed by the accomplishment of my second day it didn’t matter how it ended. It took me six months of practice to be able to make it. In life, is not about how fast you make it, but is to make it to the finish line.  Is also about enjoying the moment and each step of the journey no matter how painful it is.  On my second day I did both.  I am deeply grateful to my creator for the opportunity of living this experience and the wisdom that it has given me. I hope that I can apply this lesson to my daily life, so it could be an encouragement to me and to others. The harder the journey the bigger the triumph.

For those Spanish speaking please take time to read the following poem. It's about a condor and a snail on their trip to the top of the Andes. It was given to Mildred and me on our graduation from Junior High School. We both were part of a poem group; I was the voice of God. This poem has inspired me through my life, hope it does the same for you (we will work on the English translation).

Poema el Condor y el Caracol, a draft made on July 10, 2009

(we both where 15 years old when we first memorized this poem, back in 1975)

El cóndor vanidoso se levanta  diciéndole al humilde caracol, veas aquella montaña tan alta como el Sol? Es una cumbre andina y hasta su propia cima tan solo sube un Condor como yo. Respondió el caracol humildemente; suba su majestad que yo  lo sigo. Batió el ave su alas  y al instante pósese altivo en la montaña Andina. Volaba el Cóndor por una y otra cima. Y al pasar mucho tiempo en una cumbre detuvo sé cansando.

Mas cual no fue su asombro un último esfuerzo El Caracol hacia y a la cumbre subía. Como llegaste aquí Vil Atrevido? Respondió el Caracoleó humildemente. Señor he subido hasta la cima noblemente. Subía aquí descansaba allá. Descansaba un instante y ascendía.  Mientras cómodo en la cumbre tú te hallabas, yo dando tropezones persistía. Y al fin aquí me tienes compañero tú no eres el Señor de las aturas. Otros suben a la cima. Unos  vuelan como tú y  unos brincan otros corren o se arrastran  como yo. Pero al fin compañero todos suben.

Una voz de lo alto resonó “bienaventurado los que se arrastran los que luchan y persisten los que saltan los tropiezos los que brincan las paredes que los tienen Prisioneros Los que dicen es posible hare mi supremo esfuerzo. Sepan pues los caracoles que la Gloria alcanzada tras la lucha es de todas las glorias la más noble”.

Todos suben compañeros todos suben unos vuelan, unos corren, unos brincan o se arrastran como yo  pero al fin compañeros todos suben. 

Choquequirao Trip - Day 3 to 8

I finally find myself with time and the state of mental and physical well-being to be able to resume my journalizing of the trip. The trip through the mountains was both physically and mentally a challenging. I used every time and energy to accomplish the Journey and experience the mystical events and admire the amazing beauties that besiege me. My brain is not entirely back the are segments of my memory bank that are not accessible and I am still not fully here or there. Nonetheless I will like to Share some of this memorable experiences.

Let me start from saying how proud I am of being able to complete this 5 days trip. It has being the most physically grueling and challenging event in my life.  This was my maiden voyage and could have being a better one. I had to use every cell, every bit of energy and use every motivation talk to finished but I did. I was the snail crawling up the mountain but I finally reach the summit and was visited and welcomed by the majestic Condor keeper of the Andes.

My eternal gratitude to my group without which I could I have started. There love, support and compassion where instrumental. Also my gratitude to the Shamans and the guides and support workers, without them we still be in base camp.

Day 3.

The Choquequirao hike was very challenging. It required for each one of us to be ready to hike 6 to 8 hours a day. This terrain was very uneven and had many hills. Choquequirao sits in the saddle of the high of the Andeans ridge, 10,000 feet above sea level.  The city is an inspiring example of an elite Inca ceremonial center. It was dedicated to the worship of the mountain Gods or Apus, the river and all the other elements of natures. Choquequirao, the other Machu Picchu means "Cradle of Gold" in Quechua, the Inca´s language, although this is probably not its original name. It is another "Lost City of the Incas" rediscovered officially late in 20th century located high on a ridge spur almost 1750 meters above the raging glacier-fed Apurimac River and surrounded by towering Salkantay and Humantay snow-capped peaks.

Choquequirao was built during the last days of the Inca Empire in the government of the Inca Pachacutec 1490, by Tupac Inca Yapanqui, and probably after the Spanish invasion in 1532. Almost 40 years the Inca's held stand against the spanish conquerors (between 1536 - 1572). The construction of the different levels of temples, palaces, canals and aqueducts is really fantastic. “Choquequirao is the city which demonstrates the inspiring example of an elite Inca ceremonial center. A city dedicated to worship the “Pachamama” the Andean mother earth “the Apus” mountain gods and divinities, the river and the elements of nature."

http://en.wikipedia.org/wiki/Choquequirao

I was mesmerized by the beauty of the mountains and the rivers and streams. I spent the majority of time in a sightseeing mode. We did a ceremony to asked permission from the Mountains to enter the domain.  While the ceremony was being carried by Carlos, our Shaman, several eagles were flying over us and flicked there wings like blessing our entrance and giving us the welcoming from the Apus mountains.  We all felt so special, so full cover by sublime energy of tranquility and greatness.

We where so intrigued by the surrounding beautiful scenes that most of our time was spent taking pictures and appreciating it. We stop so frequently to take pictures, that I am sure this explains why it took us about 9 to 10 hours to make it to first camp site when it should have taken just around 6 to 8 hours. We made it on the dark of the night as we attempted to hike with flashlight and head lights. It was quite an experience to hike down these narrow and rocky trails in the middle of the night.  It was so good to finally make to our first camp site safely and with all our body parts.  It was the first big achievement.

We finally made it and our trek was setup and soon the food was READY.  While eating, we discuss our slow day progress and the need to sleep it up for the coming dates. Our dining room was set in a basic, simple structure made of tree branches and cover by some kind of dry leaves. Despite its simplicity, the food and service were exquisite and delicious. Was as good and as elegant like any five star facility. Modesto, the main cook and his crew, certainly created high standards for days to come. Rooney, our team leader, was so tactful with us through the night never making us uncomfortable with our first date achievements; however he reminded us of the need to speed our process so that we can finish our second day in timelier manner. What a wise man!

At the end of the night I went to my tent where Dirk and I had all our equipment and our stuff.  Even though it was a crowded place and the accommodations were small, it didn’t bother us too much. I was too tired and too impressed by the experience.   That first night I woke up to empty my bladder. The night was cold and the fogs covered the mountains. When I looked up, a space cleared over the skies and a single bright star was shining and blinking which I felt was straight down at me. I was so overtaken by the moment that I closed my eyes and Oh my God!  When I open them again the star was gone and that was the only night that the star ever appeared. I felt like God was telling me - I welcome you and will guide you in this trip and in your life.  I felt the graced and the blessing that was given to me in that spiritual instant.

For the rest of the night, it was difficult to fall asleep. I was enjoying the experience. I was being soothed by the surrounding sounds of nature. I finally fell asleep.

Day 2 - Trip from Lima to Cusco

We arrived at Lima to the hotel in Miraflores at midnight after a long day that started for me at 4:00 a.m.   We waited a lot but I made the best of it by reading from my Kindle. The flight to Lima Peru took six and half hours. On the second day we were on the way to the airport by 7:00 am. I just had four hours of sleep but it didn’t matter because the energies where running high. 

The flight to Cusco was short; we arrived by mid-morning to a city with a radiant sun and in a festivity mode. The entire city was celebrating the 100 years of the rediscovery of Machu Pichu. This was accomplished by Hiram Bingham; explorer, professor, and archeologist from Yale University.  Cusco is located in los Andes in the southern part and is at an elevation of almost 11,000 feet.  It’s the heartland of the Inca Empire that lasted until the 16^th century.

Today, the city was sunny and majestic and the air was full of festival.  Everybody seems to be out in the streets and they were full of parades and performers.  We took some time to rest our bodies and then went for a walk thru the city and then to a nice local restaurant to have a light meal (when you are at this altitude heavy meals don’t get digested well).  We had an opportunity to meet and talk with the other tour guides; Carlos and Ronney, both have a profound worth of knowledge and wisdom.  They are very connected and informed about the Inca traditions and the spirituality of this trip and hikes. I felt blessed and honored to be in the presence of such unique and mystical men.

Tomorrow we are going to Coguguirao, the other lost city and the city city of Machu Pichu. This ruins were rediscover in 1993 and they are only twenty percent explored.  It’s a six day hike 3 going and 3 coming back.

Now I have to go to sleep and be ready by 6:00 am. I will enjoy my experiences over this phase of the trip an will bring lots of memories and pictures.

Be well and best wishes to all.

My love to Mildred , Ale and Andy, Leo and Albertito.

I miss you guys! Un fuerte abrazo.

Peru Day One

Thanks to the help of my great wife Mildred, my friend Dirk and the outstanding job of Imelda our old friend and now executive assistant, the date came and I was fully ready.  Having Carol as a leader made a world of difference. She was constantly sending updates and reminders. What a great facilitator.

In this trip every packed item has a value and significance but none as my NY Yankees hat and my red hiking shoes.  The Yankees hat represents part of my history and traditions that I cherished and have many fond memories.  I was born in the Bronx nearby the stadium and as a young I remember like it was yesterday when I went to the games. They were family events, full of joy.  I always look forward to the special kid’s dates.  On those I will get a treat: a bat or ball or a hat. I felt so special and important. Almost all the times I was taken by Vitin, my favorite uncle. He was the one that gave a lot of good memories from my time in the city and my visits to spend the summer away from the island. He was my # 1 uncle.  Interestingly enough, I use my hat in any significant trip or life event; it makes me feel grounded and connected.  In my recent diving trip to Bonaire where I was together with Alejandra, my oldest daughter, I lost my hat - blown away by the strong winds on a boat trip. It was an old one with lots of mileage. Days before this trip Albertito my nephew brought me a new hat engrave with my name and the phrase # 1 uncle. He had no idea that I have lost my old one, but knows how much I love the Yankees.  We have a special bond and the gift is a manifestation of it. So for now I have a part of my past that grounds me traveling with me in This Divine Journey.  As Carol said: “the more grounded you are, the more open you are to connect with the higher self.”

My red hiking shoes are what guide me in this Journey. They give me direction to follow my path, my discovery.  They also ground me to my core, my values, to my family, mentors and friends. There are red and shine. They are my beacon of light. They guide me through my Yellow Brick Road. 

Talk to you guys soon after day two.  It will be shorter. Thanks for listening and I hope that this message has brought you value. Again thanks to all that made this trip possible and for the Love of Mildred, my wife and help of Leo, my first nephew on helping creating and maintaining the Facebook Business Page.  Without all of you, my BHFC peers and staff and great Moses this will have just been a dream and not reality.

My boundless gratitude to all.

Best wishes and be well!

Peru a Divine Appointment

A spiritual journey to reclaim and reconnect with my spiritual self, one of rediscovery, one of search of wisdom and enlightenment and an opportunity for growth.

Why Peru again? As you can see from our old pictures we visited Peru in 2009. It was great family vacation except that Alejandra our older daughter could not accompanied us. Her duties as a performer on In the Heights on Broadway precluded her form making the trip.  Peru is an amazing country. Full of history, art, architecture, plazas and rich multicultural traditions. It also has progressive cosmopolitan sites in Lima the capital. It is a beautiful and organized city. They have great restaurants with outstanding cuisine.

We had an opportunity to visit both the city of Cuzco and The Ancient City of Machu Pichu. This was majestic and exceptional. Both cities are very unique and rich in indigenous Inca’s traditions. The train ride to Machu Pichu was breathtaking. We were surrounded by snow covered Andes Mountains.  The train was following alongside a majestic river. All along the trip we could see some of the ruins from old Inca cities and structure.  Needless to say we were mesmerized by this trip. We promised ourselves to return in two years , in time to be part of the 100 hundred years of the discovery of the lost city of Machu Pichu.

As 2011 approached,  I was contacted by my best friend and male soul mate Dirk Magdahl  to make the trip  with  Carol Master’s group.  Carol is Reiki certified massage therapist. In addition she is an Iron Woman , Tri-athlete, a cyclist a runner a swimmer, a great woman ,friend , mentor an above all a great healer. After meeting her and the beautiful connected ladies in her group it was easy to say: “I am going with them.”

Since January I have be blessed by joining their group to train for the trip. We have met several times to hike and bike. I by myself started to be more committed to my exercise program and better eating habits. I have lost some of my belly weight and reduce my fasting blood sugar from 115 to 84.  I am devoted to develop healthier life styles that we help immediately with controlling my insulin resistance. In the long term I am looking for an happier, healthier and joyful life. Hopefully one with many years to come around my family friends and BFHC patients and staff.