Dr. Ed Rogers: Holistic Medicine

Ed Rogers, M.D.

Find a comfortable position. Take a slow full breath through your nose. Hold this in-breath for five seconds. Then slowly exhale. Repeat. And again. Did you, perhaps, note an interaction between the mind and your body? Did you begin to feel a subtle change? I sat down with York internist Dr. Ed Rogers who focused much of his energy on bringing the mind and body together in his medical practice. How did he get there?

“I grew up Catholic and went to parochial school till the sixth grade,” he said. “What the nuns did really well, what I took away from them was this: the sense that everything about Life and God was a mystery with a capital M.  Even as a young boy he knew that there was something out there “greater than us.” And he wanted to mingle with that Mystery.

Born in Baltimore, Dr. Rogers grew up in Pasadena, between Baltimore and Annapolis.  He and his two brothers often played by the Chesapeake Bay. (Sadly, his younger brother has passed away.) They had fun in nature. When it was time, his father, an architect, told his son that he needed “a reason” for going to college.

Ed thought of following his father’s fine example, but being left-handed, his father warned him, would be a huge disadvantage (before computer-aided drafting made that irrelevant). He should probably look elsewhere. Ed listened. He wanted to find something that was valuable in itself and he was drawn to the idea of medicine.     

He majored in zoology (actually biology) at Duke, but was careful to take courses outside of the hard sciences to broaden his perspective on life. Being a premed was tough, and he worked hard. So hard, in fact, that he missed two Grateful Dead concerts and a campus appearance by Bruce Springsteen. But he liked being on the water and he joined the Duke sailing club and enjoyed a few special trips through the Bahamas. Ed graduated from college in 1978.

Duke Chapel (from KEnZPhotography)

He worked in a virology lab for six months and then taught white-water canoeing before going to medical school at the University of Maryland. The study of medicine was hard and, as a “mere mortal” he was tested, he reflected.

At the end of his "exciting, exhausting, and humbling" freshman year of basic science, he took a one-month rotation with a Dr. Greg Pinkerton in Eglon, West Virginia. This young idealistic doctor had only finished his internship, and yet he was the town physician. Ed had a formative experience;  Dr. Pinkerton was a good teacher and kind to all. “Hey! This might be something I could do,” he thought to himself, excitedly.

That was his first mentor, but the infectious disease specialist Dr. Frank Calia and rheumatologist Dr. Wolfe Blotzer “made us better than we believed ourselves to be. He helped us to develop confidence,” noted Dr. Rogers. His first encounter with Dr. Blotzer was at an hour-long clinical-correlation lecture where Wolfe lamented that the average student remembers only the first five minutes of a talk.

The evidence of that? Well, Ed said, with a laugh, that he recalled Dr. Blotzer’s introductory remarks, but that he had “no idea what he said after that.” An hour really is too long, and maybe the TED Talk rule of no more than 18 minutes makes sense. Attention wanders after even ten minutes.  (I can sense that you are beginning to lose focus already, your thoughts are probably headed somewhere else. Please pay attention. Try to stay in the present moment.)

J. Wolfe Blotzer, M.D.

But after a talk people do remember how they felt; the primitive emotional limbic system is slow to forget.

Anyway, Dr.Blotzer popped up again teaching him physical diagnosis during the second year. He demonstrated how to take a “patient-focused” history that “asked about the person” and “how the illness affected their life.” This mantra was repeated over and over; it eventually sunk in.

Through medical school, Ed didn’t especially take kindly to surgery or obstetrics, but he enjoyed everything else. He decided to go into the broad field of internal medicine. When the time came for residency Wolfe showed up again and advised Ed to take a look at the York Hospital program. He did that and was quite impressed by the strong medical staff; they liked him, and he “matched.” He came to York in 1983.

“Did you bring something different (than your peers) to the practice of medicine here?” I asked.

Pausing briefly, and thinking carefully, he said Yes. He felt that he brought himself. "I thought I was a good listener," he said, "and I felt strongly about the importance of self-care and lifestyle changes as being fundamental to one's health and well-being." And his desire to get to know his patients through ongoing relationships over time, to take the long and holistic view of good health, not simply illness, as was the focus in medical school.

After finishing his residency he did a fourth year as Chief Resident.  Dr. Rogers then joined the private practice with Drs. Fred Kephart and Steve Kreiger in 1987. He quickly saw that the medicine he was taught in school did not always address the patient’s real needs. 

Many (if not most) of the people a doctor sees have chronic conditions and vague symptoms that can’t be cured or alleviated by specific medicines or surgical techniques. Anxiety and fear about illness, and about life’s struggles, make things worse. It is said that a caring compassionate doctor can help alleviate suffering just by his or her presence. The placebo (“placebo” means “I will please”) response in the effective medical encounter is powerful and is accompanied by changes in brain chemistry and neural activity (as I am told by my husband).     

In his mid- to late-thirties Dr. Rogers tried mindfulness meditation to help him connect with the mysteries that still tugged at him. He took up a regular practice of this, and it helped. It then occurred to him that he could bring this gift of self-awareness to his patients as part of a holistic approach to health. This would also include informed self-care, balanced healthful nutrition, regular physical exercise (including yoga), other relaxation techniques, and restful sleep. But he did not know how to proceed.

He found a three-day workshop for the teaching of stress-reduction to cancer patients. Someone advised him to “check out Herbert Benson,”  the Harvard cardiologist who described “The Relaxation Response.” This idea was based on meditation traditions but stripped of their overtly spiritual or religious features. It was geared to help his heart patients cope with the stress that affected their cardiovascular system. The stress that delayed recovery from acute events and it often worsened the underlying disease.   

Dr. Jon Kabat-Zinn with Dr. Herbert Benson

Dr. Rogers took up the challenge. He did three intensive retreats with Dr. Benson’s group, and he was energized. He then was fortunate to meet Dr. Jon Kabat-Zinn, developer of Mindfulness-Based Stress Reduction (MBSR), and did two stimulating workshops with him. Good scientific research into the emotional and physical effects of meditating and yoga was just beginning to be available, making these “new age” or “alternative” practices slightly more acceptable to an ever wary medical establishment.

(Several decades ago “someone” handed me a book, The 28-Day Yoga Exercise Plan, to help me give up my seemingly-harmless “social” smoking. The slim woman in the stark black-and-white photos wore a pale leotard and matching tights; the now-ubiquitous patterned and colorful yoga pants had not been invented. I managed to do some of the positions and easily stopped smoking. Did the yoga itself help me stop, or did the giving of the book? Or were both needed?)

"I can't breathe, I can't breathe..."

The meditation and breathing techniques Dr. Rogers learned from the masters helped him cope with his own stress of raising two daughters (with his ever-supportive wife) and “working too many hours a day” in a busy primary care office. With this experience, he was ready to share his knowledge; he knew he had something. 

One day he cornered one of the York Hospital administrators, and, with his usual zerizut (see below), he said that running a stress reduction program and teaching meditation would be a great idea for the community. But York was not quite ready. 

Undeterred, Dr. Rogers said to himself that he and his patients were ready.

He started slowly with his office staff (practicing on them), and they mediated together during lunch break. (I hope no one was so relaxed that they fell sound asleep and couldn't get back to work.) He then cautiously offered simple guided meditation exercises to a few of his patients. After a while, he developed the confidence that he “could teach this.”

A year after his idea of an innovative program for stress reduction was nixed such things had caught on elsewhere, and the York Health System was more open to it and the broad field of complementary medicine including acupuncture, massage, yoga, tai chi, and nutrition. The mind-body interaction was integral to a holistic approach to well-being.

So, along with psychologist Jere (Kottkamp) Howell, Dr. Rogers started the program with eight-week stress reduction sessions modeled after Dr. Benson’s approach. His co-leader unexpectedly left the area the following year (2000) and he then ran the comprehensive Mind-Body Center himself (and worked full-time in his regular practice) until 2014. He was very happy to see the successes (and that mindfulness itself was rapidly becoming mainstream and part of our culture). 

He enjoyed the challenge of spreading the word and the practice of mindful attending to the present moment.

Over the years Ed kept up his personal practice of meditation and mindfulness. He learned to take a few deep breaths as a “sacred pause” and to feel his feet firmly planted on the floor before opening the exam room door to warmly greet the next patient. He learned to “focus” intently, to listen closely with compassion, and to give his patients “the time they need.” 

What are the effects of non-judgmental conscious awareness of the present moment?  The practice of mindfulness meditation, often focusing intently on the breath and letting intruding thoughts pass without judgment, can induce the so-called “relaxation response” described by Dr. Benson. This voluntary activity engages the parasympathetic limb of the autonomic nervous system, the system of “rest and digest.” Blood pressure, pulse, and muscle tension decrease, and markers of inflammation (like CRP and interleukin-6) diminish, as stress hormones of “fight or flight” (such as adrenaline and cortisol) fall. This sympathetic/parasympathetic balance is tipped and the effects are widespread. 

Functions of the autonomic nervous system

Brain structure is also affected. One study of new meditators showed that as little as an eight-week course in Kabat-Zinn’s MBSR resulted in increased gray matter in brain areas associated with learning, memory, and control of emotion including the hippocampus. There was a decrease in the density of neuronal gray matter in the amygdala, the key site of the fight or flight responses of fear and anxiety (Marchant, p. 170). 

Hotzel, BK Psych. Res. 2011; 191(1): 36-43

Dr. Rogers told me about studies on telomeres. (I had absolutely no idea what he was talking about but my husband helped, once again.) Telomeres are structures at the ends of strands of DNA, and the longer the telomere the longer the life of the cell it is in.  The enzyme telomerase slows the age-related shortening of the telomeres. Studies have shown that meditation may lead to increased telomerase activity, and may slow the aging process (Goleman and Davidson, p. 177).

Experienced meditators and veteran yoga practitioners likely have long-lasting changes in brain structure and connectivity, and there are new enduring "traits" not simply passing "states." There is much to learn about how mindfulness and other forms of meditation modify the brain and affect the autonomic nervous system (and the endocrine and immune systems), but there has been little doubt for thousands of years that what happens is beneficial. 

How the practice (and some type of meditation is seen in all religious traditions) affects the soul and informs ethical (social) behavior may be even more important, and a more profound mystery.     

Three months into “the very edge of retirement,” Dr. Rogers feels that “in the long run” he did what he “set out to do.” He rediscovered some wonderful ancient tools to help himself in his own spiritual journey and tools to help his patients cope with illnesses and suffering to bring about well-being. He doesn’t know what the future holds as he and his wife move to Vermont (one daughter is in Boston and the other lives in Upstate New York) but, as Ed says, “that’s exciting.”

There is a Vipassana, or Insight, Meditation Center a few minutes from where they are moving to, and Dr. Rogers plans to check it out.



Sitting quietly,
Doing nothing,
And the grass grows by itself

(Matsuo Basho 1644-1694)

Photo by S.C.

Readings:

1. Benson, Herbert, M.D. Beyond the Relaxation Response. New York: Berkley Books, 1984. (Still relevant.)

2. Golman, Daniel and Davidson, Richard J. Altered Traits: Science Reveals How Meditation Changes Your Mind, Brain, and Body.  New York: Avery, 2017. (The best review of the science.)

3. Hittelman, Richard. richard hittleman's Yoga 28-day exercise plan. New York: Workman Publishing Company, 1969. (For the pictures.)

4.  Marchant, Jo. Cure: A Journey into the Science of Mind Over Matter. New York: Broadway Books, 2017. (Highly recommended.)

A Definition:

Zerizut: A Hebrew word that is often translated as “zeal,” “alacrity” or “promptness.” Zerizut is the spark that catalyzes us to quickly and effectively do the things that need to be done. However, according to Alan Morinis, it may more accurately mean clear, deliberate, single-mindedness. This may be achieved, of course, through a meditative practice (see article).