Jayson:

Well Doctor Yu, I really appreciate you showing up on the show today. It's great to have an actual rheumatologist that's also dealing with an autoimmune disease. So welcome and how are you today?

Dr. Micah Yu:

I'm doing well thank you. And thank you for bringing me on your pocket. I really appreciate the fact that you have Ankylosing Spondylitis. You're really helping the masses out there.

Jayson:

It's fun to do. And I learned something new every day after almost 40 years of dealing with this. I still realize I don't know anything. So it's just neat to keep learning. So, you have such an interesting position, not only are you a rheumatologist, but you're working on your Integrative Health Fellowship right now. Could you explain a little bit to the listeners’, kind of what Integrative Health is or Integrative Medicine is?

Dr. Micah Yu:

Yeah, so I'm definitely doing several things. So I'm certified in Lifestyle Medicine with a new specialty. Now, it's from the American College of Lifestyle Medicine that focuses on six pillars. It focuses on nutrition, exercise, sleep, stress, emotional well being and tobacco and risky substance cesation, but also taking courses in Functional Medicine right now as well. And I'm doing my second fellowship in Integrative Medicine at the University of Arizona Andrew Weilprogram. So that program is what I'm most excited about. So that program not only goes over nutrition, but also goes over different complementary or alternative modalities such as traditional Chinese medicine, Reiki, ayurvedic, supplements, manual medicine, mind body medicine, meditation, and so forth. Yeah, so those are the things that it covers.

Jayson:

So in my past episodes of the shows, I've done episodes where we've discussed, you know, working with or finding a rheumatologist using meditation, in some cases, yoga, all these different things, and what you're really doing is kind of wrapping it all up into one specialty.

Dr. Micah Yu:

Yeah, that's, that's my goal. I really want to combine the world of traditional allopathic medicine with complementary medicine. I think that's where the most benefit life of patients and that's what I want as a rheumatologist, and that's what my patients are speaking as well.

Jayson:

So as a rheumatologist, when you're working with patients, I get a lot of listeners as an example, that say, I can't get my rheumatologist to believe that I think I have as they want to keep telling me I have something else. I always wonder, do you continue to be your advocate for what you think you may have? Or do you follow the course of path that the rheumatologist is going or if it's just a head, but do you look for a new rheumatologist? I never know what the correct way to look at it is.

Dr. Micah Yu:

Yeah, so that's a very tricky question. Rheumatology is probably one of the most difficult fields in medicine to practice and there are still many questions, still nebulous answers as well. So I would say as a patient, if you feel like you have Ankylosing Spondylitis, and you're not getting the answer from your doctor, I would seek out a second opinion from another rheumatologist in the area or virtually as well, because sometimes the rheumatologist can have three rheumatology in the room and all three rheumatologist will have a different opinion. So it's very important in rheumatology to get that second opinion, to see if it matches up with the first opinion.

Jayson:

And what about things like maybe you haven't been diagnosed yet? I would think that x rays and MRIs can be very important to at least at a minimum set a baseline to say here's what my spine here's what my hips, here's what everything looks like, how does it look like six months a year, however far in the future?

Dr. Micah Yu:

Right, so actually, the imaging are definitely very, very important, especially if the rheumatologists really suspect Ankylosing Spondylitis. So actually it is the first line imaging and all patients that come in with suspected ankylosing spondylitis. If that doesn't show anything, and the patient still is symptomatic, then MRI of the pelvis is second line you do want to see hopefully stay on the MRI and still, however, if you don't see any x ray or MRI changes, that doesn't rule out Ankylosing Spondylitis. There is a patient population that has a diagnosis of non-radiographic axial spondylorapathy, which pretty much means you have Ankylosing Spondylitis without the radiographic changes.

Jayson:

It's very interestinga and I did an episode not too long ago about how maybe this disease has been looked at a little bit wrong and that instead of using non radiographic and using Ankylosing Spondylitis, we might say that everybody just has axial spondyloarthritis and they move along a path from non radiographic to the AS, works on a spectrum. And I thought that was kind of an interesting take on it.

Dr. Micah Yu:

Yeah, you know, both diagnoses are pretty much the same to me. They're both the same management. It's really a matter of whether you see inflammation on that film or not. And it's really important for the rheumatologist and when you do suspect, ankylosing spondylitis and the radiologist doesn't say anything about the edits or any changes on there that the rheumatologist hopefully does talk to the radiologist and really confirm that imaging findings because there have been times where there has been nothing found on the radiologist repo. When I reviewed with the radiologists they change their opinion.

Jayson:

Okay, so it's very important that everybody put their heads together and work through, there's a lot of pain present in the patient.

Dr. Micah Yu:

Right, exactly. Especially if the rheumatologist doesn't really send much info to the radiologist every other sometimes doesn't know what to look for. So they might overlook it. 

Jayson:

Interesting. Now with that we're in 2020, we're actually coming to an end here, and you have your practice. But what many patients have experienced in 2020 is working virtually with a doctor, you know, just through zoom or whatever, FaceTime through the phone, whatever way they work, you are in California, but you're also licensed in eight other states besides California, could you let those most of the listeners know that you are a possibility they could talk to?

Dr. Micah Yu:

Yeah, so I am currently licensed not only in California, but just going from west to east, I'm licensed in Arizona, Colorado, Texas, Illinois, Michigan, Ohio, New Jersey, and Florida. And if any of your listeners want to see me virtually, and they're not looking at any of the states, I am more than happy to get another state license, it just takes time. And it's so important for me to get licensed in other states and I the reason why I'm doing this is because there's not many rheumatologist practice the way I do and there's a lot of patients out there that are seeking a rheumatologist just like me, and I really want to help those patients out there because I'm a patient myself, and I understand how important it is to find a rheumatologist that really fits your style.

Jayson:

Yes, we really didn't cover that you are dealing with your own autoimmune disease. So you're not only aware of how you feel dealing with it, it brings a little bit more, I would think empathy towards people that are coming in to see you

Dr. Micah Yu:

Correct, yeah, so I can definitely go over my story, which has led me down this path into integrating complimentary with traditional rheumatology. So during high school, I was a football player, and I wanted to lose weight and gain strength as well. So I went on the Atkins diet, a high very high protein diet of about 150 to 200 grams of protein a day when I was only weigh about 150 milligrams, 150 pounds. I mean, so I went into that for a couple of weeks to column one and got a diagnosis of gout. I woke up with a really painful, swollen toenail and I got diagnosed with gout and over the years, my pain really transformed to another form of arthritis and I want you to put rheumatologist during medical school and they really couldn't really diagnose me. Typical story, right? You go from doctor to doctor and, and rheumatology and they don't have an answer for you. All my labs are negative, my HLA-B27 was negative, but my inflammation markers are elevated by ESR and C reactive protein. So during my residency, after medical school, I want you to remember I told you the department and my program at Loma Linda University and the inital diagnosi spondyloarthritis. Now my spondyloarthritis is a variation of Ankylosing Spondylitis, I don't have the lower back pain, but I do have to enthesitisis. So enthesitis is basically inflammation of this insertion point of the tendon and bone bone. I do have that, I do have joint pain in the hands of the knees and all these other places. So I have several diagnose gout, I actually got diagnosed pseudo gout and I got diagnosed with periphrial spondyloarthritis. But periphrial spondyloathritis is the main autoimmune condition that I have. And if you want me to dig into my story, I don't take medications. Actually, I control it with diet and lifestyle. And would you like me to go over that as well?

Jayson:

Sure, we get a lot of listeners are nervous of taking the medications. I personally take Cosentyx, I've been taking it for several years. And it's been phenomenal for me. But the Ankylosing Spondylitis, the autoimmune disease journey is different for everybody. And so for your case, you're controlling with diet, and there are so many people that are interested in that. I'd love to hear how you do that in conjunction with your wife, right?

Dr. Micah Yu:

Yeah. So yeah, so before I started my fellowship, you know, I went on a whole food diet, and within a couple months, my joint pain went away. My C reactive protein, which has been elevated for over 10 years actually went negative for the first time I was pleasantly surprised. The reason why I want to whole plant based diet is because my wife is also a doctor, and she's part of the American College of Lifestyle Medicine. And I read College of lifestyle medicine, and they promote whole plant based  diet, so I figured I'd give it a shot. It's anti-inflammatory diet. There's many anti-inflammatory diets on the market. That is a paleo diet is a Mediterranean diet. And now there's a whole plant based diet as well. And it's been it's worked for me, it doesn't work for everybody. Every individual with ankylosing spondylitis and autoimmune disease is different. So I'm very balanced in that aspect. And not everybody will control their autoimmune disease with diet alone. I'm one of the lucky ones that can. I do take medication for gout. I was off my medication for my gout for over a year. But I noticed that my pain did come back or actually over two years I noticed my pain did come back during times of stress and ignores those working to get them to the spondyloarthritis so I don't take any medication for much on those various I do just fine unless I'm working overnight and I'm very stressed, it does come back. But my pain that was about 10% of what it was before.

Jayson:

Wow, in this, I think is a great time to talk with your wife. As a doctor, as you said, you guys have created a book together and ebook. And again, a lot of listeners and a lot of people in the forum's all want to talk about different eating styles and what works, and I think you're correct. Not everybody can do Keto and get the same results. Not everybody can do Paleo and get the same results. But it's worth trying it to find out, oh, this did work for me or it didn't work for me. It's part of that journey you go on and with that you guys did an ebook. I'll have a link in the show notes to Dr. Yu’s website where you can actually purchase the E book. And it's all on plant based cooking, if I understand?

Dr. Micah Yu:

Correct, yeah, so my wife is avid cooker. She makes great recipes. We actually have recipes on our website. But my own personal website, I do have that book and that basically goes over ways to get started on a whole food plant based diet. The whole food plant based diet has helped many different conditions not only on disease, my wife is assigned medicine doctor, she's actually seen the reverse of hypertension and diabetes has actually been able to get patients off of their medications for both conditions and sometimes she has even reversed patient’s cholesterol as well. So it's an auto-inflammatory diet. Inflammation is the one of the root of many diseases. That's why it can work for many conditions and that's why we do live a whole food, plant based lifestyle at home.

Jayson:

If you are thinking about getting the book, I'll also have a link to Dr. Yu’s YouTube channel, where he's got four videos, it's relatively new channel, he's got four videos cooking for different plant based foods. And one of them is a dark chocolate avocado pudding, which looks great. And so this will give you an idea of, of kind of how you can incorporate a plant based diet if that's what you want to do into your treatment plan for your Ankylosing Spondylitis.

Dr. Micah Yu:

Yeah, thank you so much for mentioning that, Jason. So yeah, we do have a YouTube channel. It's a cooking channel, but we haven't updated yet. But we're going to actually start that YouTube channel back up in the next couple months. So stay tuned for that, there is the chocolate avocado pudding recipes, there's currently no refined sugar in that. So a whole food plant based diet is pretty much a vegan diet. Without processed food, it can be quite challenging for someone that can eat regularly, it is a journey for me, I was a big meat eater in the past as well. But because of my improvement in pain, I basically cut the meat out of my diet,

Jayson:

That would be a hard one for me, I'm not going to lie. Yeah, I'm not going to lie, that would be a very challenging one for me. Brussel sprouts with a steak all over it, but I do prefer lean meats, I do hunt. So a lot of what I eat is a wild game, which generally tends to run on the very lean side, I eat very little in the way of, you know, store bought before or anything of that nature. So there's studies out there say, hey, that's not bad for you go ahead and ingest it. Your body knows how to handle it and there are other studies that say don't do it. Yeah, so that’s kind of all over the place. So you got to really work with somebody like yourself, set a course try it. If a plant-based diet doesn't work for you, you know, your rheumatologist if it's Dr Yu or anyone should then say, Okay, you've tried it. Let's try this. And it's really a process of elimination to find out what's the right one and and you need a doctor that's going to help guide you through that. And that's, that's why I think that integrative medicine and the functional medicine that you are incorporating with rheumatology, I think that's just so important,

Dr. Micah Yu:

Right, yeah that's why I'm doing what I'm doing. Because there I was looking for a rheumatologist like this as a patient. That's why I'm going to become that rheumatologist for other patients as well. You know, as a physician, we don't get trained on nutrition; the nutrition training that we get during medical school is only 10 hours at most. And it's things like vitamin C deficiency, things that we don't really see, on a day-to-day basis. Things aren't that practical. So for me, it's really important to basically go on that journey and find out what is the evidence in nutrition, what works for patients, how to talk to patients and find a balance in that your rheumatologist is most likely not going to be well versed in these diets and how they can help with inflammation. That's why I'm doing what I'm doing out there. And you know, even if you don't decide to go on homeopathy said it's important to incorporate vegetables, the fiber is so important for you for anti-inflammatory effect. So even if you decide not to go whole plant based, you can at least incorporate more vegetables, and that's where some of our recipes can come in to give you ideas on how to do that.

Jayson:

Oh, yeah, I'm not always the best at eating the vegetables. I should but I had a friend turned me on to putting cauliflower on a baking sheet putting some hot sauce on it and putting it under the broiler. Dr. Yu if you would have told me 10 years ago I was going to do that I would have told you to get lost. It's fantastic. It's absolutely fantastic and it's so much better than sitting down with a bag of chips.

Dr. Micah Yu:

Oh yeah. You just need to learn how to cook, what recipes and make it taste good and that's all you really need. You know, before I went on this journey, I hated eating vegetables myself, I didn’t like the taste of it. But once you find variety and experiment with cooking, it really is fun and tasty.

Jayson:

Now one thing I want to cover with you so that the listeners understand is, well you're licensed in all these states and you can help you don't take any type of insurances. It's going to be a ,you work with each patient on a basis of here's what your set hourly or per visit rate is. So people need to understand that up front. But that's what allows you to work in all these different states with a much easier process, correct?

Dr. Micah Yu:

Yeah, so I don't take insurance. The only insurance I take is Medicare. The reason I don't take insurance, because the model of quality of care that I'm giving doesn't support a insurance model. You know, when you see a rheumatologist and insurance model, the most you get maybe 15 - 20 minutes at a visit, or maybe half an hour for a new fit. For me, that's not enough, I spend at least an hour on a new visit. And I spend half an hour on the first visit. And in the new visit, not only do I go over diagnosis; I go over your medications. I also talk about your lifestyle and potential alternative ways to help with your ankylosing spondylitis and autoimmune disease. So it's a very, very comprehensive visit, and I answer questions I take time with you. And even if we run out of time over an hour, I always give direct access to my patients where they can send information through email; you can contact me through social media in order to get your answers. So I use my social media platform to educate the public on how important lifestyle and integrative medicine is to diseases in general.

Jayson:

So I'm in Michigan, let's say I decided to work with you doctor. You can write prescriptions and in all the different states?

Dr. Micah Yu:

Correct, I can write prescriptions in any state I can write loud, I can order x rays. So all medications, labs and x rays go through the insurance. The only time you're out of network is when we as a doctor in our visit, I can be your primary rheumatologist I can also be your second opinion. I have multiple patients where they have the primary rheumatologist and under second opinion and they follow the regularly because the rheumatologist is really the seeing them every time just not answering questions, just renewing the medications every time and they're not well versed in other aspects of integrative care. And that's where...