Episode 115: Integrative Rheumatologist Dr. Micah Yu

Episode 115: Integrative Rheumatologist Dr. Micah Yu


Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is double board-certified in internal medicine and lifestyle medicine. He obtained his MD from Chicago Medical School, and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He is currently in his 2nd fellowship at the Andrew Weil Integrative Medicine Fellowship at the University of Arizona. Dr. Yu is not only a doctor but he is also a patient himself. He has spondyloarthritis and gout, and uses his social media presence to bring awareness to autoimmune disease and chronic pain, and to unpack how we can use complementary medicine to fight these problems. Basically: he’s the doc we’ve all been looking for. And in this episode, we also dug into the COVID vaccine…is it safe for autoimmune disease patients? Tune in to find out!



Dr. Micah Yu integrative rheumatologist integrative medicine lifestyle medicine functional medicine spondyloarthritis COVID-19 COVID vaccine vaccination autoimmune disease Uninvisible Pod

Lauren: All right guys, thank you so much for joining us. I am here today with a very special guest, Dr. Micah Yu. You might also know him as @myautoimmuneMD on social media. Dr. Yu is an integrative rheumatologist; he incorporates complementary medicine with traditional rheumatology. He's continuing study in integrative medicine as well, and is also taking courses through The Institute for Functional Medicine. So he is all over it. He's also going to talk to us not only about life as a specialist for Spoonies, but also as someone who lives with his own autoimmune disorder! He's got spondyloarthritis. So we're going to talk about that; we’re going to talk about the COVID vaccine, which I know a lot of us have questions about. So Dr. Yu, thank you so much for joining us.

Dr. Yu: My gosh, thank you for having me on your show. Lauren. I'm so honored to be on your show. And I'm glad that we could connect not only with you, but also with your audience, a bunch of Spoonies. I connect with them very well because I'm a patient as well.

Lauren: Well, we’re all in the club together, so it's pretty awesome. I mean, I feel like I've hit the jackpot finding a doctor who is also a Spoonie who's practicing integrative rheumatology. It's sort of like, are you kidding? This is what we've all been asking for!

Dr. Yu: Thank you. I'm just trying to be the doctor that I've always wanted to see.

Lauren: And that's so exciting. So let's start at the top of the story here. Can you tell us about your practice and your personal connection to invisible chronic illness?

Dr. Yu: I currently have my own private practice in Newport Beach, California, called Doctor Lifestyle. You can go to the link in the show notes later on. But it's a practice that me and my wife started; my wife is also a family medicine doctor who had IBS, who had ADHD herself. So she's Board certified in Family Medicine, also certified in lifestyle medicine as well as, as am I.

Lifestyle medicine is centered around five pillars — stress, sleep, exercise, nutrition, avoiding risky substances, and having healthy relationships.

So that's what American lifestyle medicine is all about.

Lauren: It's really integrative and functional medicine rolled into one.

Dr. Yu: Yeah, yeah. Lifestyle medicine is the foundation to functional medicine, to integrative medicine. We felt that we couldn't work inside a traditional healthcare system. We had to get out, we felt like we would have been doing our patients a disservice, and we couldn't fly and have the freedom to help our patients that we want to. That's why we created our own private practice in California. And it really is the work from our own personal experiences as patients ourselves. If you want, I can talk about how all started back in high school.

Lauren: I'd love to know about this. Tell us from the very beginning. I want to know about your practice and how that has manifested, but also how it's intersected with your own diagnosis journey.

Dr. Yu: Let me start from the beginning, from when all the pain started, until the creation of the clinic. I went on a high protein diet, the Atkins diet, back in high school. I was overweight at the time, I was like 160 pounds; I’m short, I'm only 5'5". So I was pretty overweight, and I was a football player. But after football, I wanted to lose weight. So I went on the Atkins diet, I lost 30 pounds, and I got strong, I got the results. But I ended up getting a severe case of gout overnight. Gout is a disease that affects the joints; it’s an arthritis disease. And if you get pain in a big toe, that's a manifestation of overproduction of uric acid — typically, that's what it's from.

Lauren: Does it often come from a high protein diet?

Dr. Yu: It can, but you don't have to have a high uric acid level to get gout. So that’s what's interesting about it. It's not an autoimmune disease, but it is arthritis. And I had that starting in high school. I had it in college still. I kept flaring. I didn't watch my diet. I drank alcohol, I have fun in college. And then I got my way into medical school. Right before medical school is when my disease started transforming. No longer did I have pain in maybe just one joint or two joints. I started getting pain in different joints, five joints at a time. My TMJ, my wrists, my elbows, my fingers, knees, ankles, toes, you name it. Morning stiffness, unable to eat a couple of weeks in a row because my TMJ would be so inflamed, I wouldn't be able to open my jaw. So I would drink water, eat yogurt, or something soft. Sometimes I would limp to school, sometimes I would get fevers from the pain because you have inflammation. My dad is a family medicine doctor, so he first diagnosed it as gout. But when it started transforming, I went to different rheumatologists in Chicago where my medical school was, and they couldn't really figure me out. I had the high inflammatory markers of C-reactive protein, and ESR (erythrocyte sedimentation rate/sed rate). They tested all those for autoimmune diseases.

They said, “You know what? We don’t know. You have gout, but your autoimmune disease antibodies are negative. Maybe we just have to see how you progress over the years.” No talk of diet.

Lauren: There rarely is.

Dr. Yu: Yeah, there rarely is. And I was on medication for gout for all these years. I took ibuporofen. That was pretty much it. I flared every once every two months.

Lauren: And throughout medical school, too.

Dr. Yu:  It was horrible. I would sometimes take tests, flaring.

Lauren: How did you do that? How do you get through medical school when you're sick?

Dr. Yu: You're in, and I worked really hard to get in — and you have no choice but to get through it.

Lauren: You just have to push.

Dr. Yu: You have to push. Either you get through it, or you drop out and you're in debt. And this was my dream. I was in my dream school, my dream job. So you just do it. In life, people go through different things. Everyone has hardships. This was my hardship.

Lauren: But I mean, this is a common story, right? That it happens for people, that disease starts manifesting in high school or college. We hear this all the time on the show. And also that when you don't know any better, you push through it.

Dr. Yu: Exactly. But being so stubborn back then, even though it's transforming, I didn't seek care later on from a rheumatologist. The first and second years weren't that bad. It was just test-taking, going to anatomy lab. But third and fourth year was when it got more rough, because I couldn't stay at home any longer. I had to go into the hospital to see patients as a student. So even with a flare I went in. And then during residency was when it got pretty tough because there you are a doctor now, you are fully licensed MD, working 80 hours a week. So I remember, clearly, I would go to the ICU during my first year of residency. And I was limping to work. I couldn't lift my leg up, the arthritis was in my hip. I literally had to lift my left leg with both hands to get in the car, to get out of the car — because it was so painful. And I would limp and when you are going around the ICU for a couple hours, you stand; they gave me a chair to sit on and we would just do our thing. And that's how I got through it. Luckily, there at my residency at Loma Linda University in Southern California, they diagnosed me with spondyloarthritis, that rheumatology department. That’s where I did my fellowship in rheumatology as well.

Lauren: Did that also draw you into rheumatology? Because you were going through something?

Dr. Yu: Yeah. So once I got to medical school, I knew I wanted to do rheumatology because of my disease. And, I like being challenged. I like learning and rheumatology was one of the most difficult subjects for me. It was really complicated. But that drew me to it as well, I wanted the complexity of it. So I went to rheumatology at Loyola University.

But again, no talk of diet, no talk of lifestyle.

Lauren: Mental health support for it?

Dr. Yu: No, no mental health support. Here’s a diagnosis, here’s your meds. You’re in our program … I was very supported there. But diet, lifestyle … you don't get taught that stuff during medical school. If you do, you learn about vitamin C deficiency, which you don't see in America. It's not the fact that they didn't want to teach me about diet, they didn't know, they were never taught. So they're not at fault. It's just the way the system is built. It's not conducive to chronic pain patients.

Lauren: And yet there are more and more chronic pain patients and chronic disease patients coming through the system, too.

Dr. Yu: Exactly. A recent study showed that in the world, the rates of autoimmune disease are rising 7% a year. 

Lauren: That’s huge. 

Dr. Yu: And that's including endocrine, neurology, rheumatology, GI.

Lauren: Wow. And we know that a lot of that is partially environmental, but a lot of it is also the fact that we're now aware of so many more diseases and open to diagnosing so many more of them, right? It's like a double-edged sword, that one.

Dr. Yu: Yeah, double-edged sword. It's unfortunate, but like you said, it’s environment, it's also our genetics. It's not good, because it is exploding!

Lauren: Yeah, absolutely. And you know because you're the canary in the coal mine.

Dr. Yu: Yeah, yeah. You could see it as a curse … like, why do I have this? Like all of us … why do I have this disease? Why me? But now, I'm using it to my advantage. I haven't talked about my journey and overcoming this disease. So, my wife, as I told you earlier, she's a medical doctor in family medicine. She got introduced to lifestyle medicine from the American College of Lifestyle Medicine, and I told you the pillars are nutrition, lifestyle, stress, all that stuff. It is centered around a whole food plant-based nutrition. That's what the American College of Lifestyle Medicine promotes. So she started getting into it, learning about it, and she started cooking … I remember distinctly during Thanksgiving of my third year of residency, she cooked me a whole food plant-based meal. I was like, what is this? It's pretty much vegan food without processed food. But six months later, I started reading some books on plant-based diets. I watched some documentaries, Forks Over Knives. I don't know if you've heard of it, it's on Netflix.

Lauren: Say the name of it again?

Dr.Yu: Forks Over Knives, it’s on Netflix. So you know what … I gave a whole food plant-based diet a shot. In two months, my arthritis went away. My inflammatory markers, one a C-reactive protein went negative after being positive for 10 years. So I was, like, this is a miracle — because we are not taught this in med school or residency or throughout my trainings.

Lauren: And it also sounds like that's the kind of reaction you expect to have from a pill, from a medication.

Dr. Yu: Exactly. But I didn't want a pill. Because you know what, I said, my pain is not that bad. I'll take a pill when I start seeing X-ray damages on my joints. Because I'm a doctor, I was able to monitor myself with my boss. I was, like, I don't want a pill, there's side-effects. Just like many other patients, your audience, they don't want to take pills. I didn't want to take pills.

Even though I had pain, I noticed there was a correlation with food. I just didn't know what the correlation was.

And I didn't know how to investigate that. There's so much information on the Internet. There's so much misinformation on there that I didn't even know where to begin. But luckily I found my answer, and I’m using that to really educate the world. And I feel like this is my life's work. And that's where integrative medicine, functional medicine comes into play as well. Because lifestyle medicine is just a foundation. I learned about integrative medicine during my fourth year of medical school, from an interview trial from someone else. And each of these integrative complementary medicine fields has something different to offer. Integrative medicine, which I'm taking now at University of Arizona with Andrew Weil, it's a two-year program. And you learn about Chinese medicine, you learn about acupuncture, Ayurveda, botanical medicine, supplements, aromatherapy, mind/body medicine. Functional medicine, you learn about toxins, but the integrative method also teaches about that. You learn about leaky gut; integrative also talks about this. Functional medicine talks about different things, but not all of it is always evidence-based, so I'm trying to filter out what's real, and what's not. I feel like there's value in every field, and I can use it to my advantage to help my patients, just extra tools in the toolbox. So that's why I created our practice, because nowhere can I work for somebody in this style. I spend an hour with my new patients or even more. You have to spend that amount of time to educate patients. And my wife does the same thing in her practice as well. So here I am on your podcast, living the dream of trying to heal the world and try to figure this all out with science!

Lauren: Yeah, I love that. And it's so exciting to meet someone like you who's walking the walk and talking the talk, and literally knows what it's like for your patients. I'm also curious, because you mentioned before we started the interview, that you're also working one night a week right now at a local hospital dealing with COVID patients. So you're already someone who's in a high-risk category, but this changing the world thing is no joke to you! You're going and dealing with these patients. And you've talked a lot about COVID and the vaccine. And I wonder if you could talk to us about that work and how it's intersected with what you're doing?

Dr. Yu: Yeah, thank you for bringing that up. So I work two nights a week.

Lauren: Sorry, two nights. 

Dr. Yu: One, two, it doesn't matter. It’s just a number. So yeah, two nights a week I moonlight at a local hospital. And I do admit, I'm a nocturnist. There I see patients that come through the door; the ER thinks that this patient needs to be admitted, so I'm the one that admits them. And nowadays, it's mostly COVID. Yeah, it's hard. It's tough seeing all these patients coming through the door. We were slammed in California over the past month or two, as you know; it was a very high-stress time for all the hospitals, very overwhelming, but it's getting better now. I see patients coming in with blood clots. When you get COVID, you're at higher risk for blood clots. When you get COVID, you do have a higher risk of needing oxygen, being more short of breath. Which is different from the flu. You can die from flu; I've seen that before. But it's usually in patients that are at higher risk or they're more elderly.

With COVID, I've been seeing strokes, blood clots, shortness of breath. Some patients get heart attacks, and post-COVID syndrome is no joke.

Lauren: Yeah, that's the thing that scares me the most.

Dr. Yu: Yeah, that scares me, too. Post-COVID syndrome comprises brain fog, muscle aches, joint pain, chronic fatigue.

Lauren: It’s the new ME/CFS.

Dr. Yu: Yeah, yeah, exactly. Also some people get dysautonomia, so the heart rate jumps up, something like POTS syndrome. A high rate that jumps up all the time. Tachycardia, that’s the scientific terms. So that's what I'm seeing. You can get new onset autoimmune disease from COVID. I've seen that; I work one day a week at a county hospital as a regular rheumatologist, and I do have patients with new onset rheumatoid arthritis after getting COVID. And I have seen new onset lupus from getting COVID as well. So this is very real. I know people are scared of the vaccine, but getting COVID itself is very scary also.

Lauren: Are these people who had, perhaps, a genetic predisposition to these autoimmune conditions? Or is it sort of a spontaneous production of cells that has actually created the autoimmune capacity in their bodies?

Dr. Yu: That’s a great question, Lauren. So what we do know in autoimmune disease is that it's half genetics and half environment. So you have to have a genetic predisposition to get autoimmune disease, no matter what the cause is. Whether it's from a virus or from your diet, or from stress — or else we'd all be 100% having autoimmune disease — and that isn’t the case. So with these patients who are getting autoimmune disease from COVID, there is predisposition from genetics. That's a great question. That's a question I get a lot.

Lauren: Yeah. That's one of those things to understand, that anyone who's maybe had COVID, who's listening or is perfectly well and maybe doesn't have the genetic predisposition, you may be at lower risk of developing these kinds of autoimmune conditions. But it doesn't change the fact that you're still at risk for long COVID, or this post-COVID syndrome that you're talking about.

Dr. Yu: Exactly. Most of us will be fine when we get COVID; most of us will be asymptomatic, some of us will get flu-like symptoms, a small portion of us will get something serious. But that small portion that does get something serious, you're going to have to go through rehab, and all that stuff. And the small portion of us that do get flu-like symptoms, some of us will get the post-COVID syndrome also.

So you just can’t look at the survival rate to figure out what's going on with COVID.

Lauren: Since we're talking about COVID, let's get into the vaccine, because I know you've had the vaccine. What do we know about the COVID vaccines that are currently on the market? One of the questions that comes up a lot, and I know you're going to debunk this myth for us right away, is how thoroughly have they been tested?

Dr. Yu: That's a great question. There's a couple of versions now on the market. I don't know about the ones in Asia, I haven't investigated that too much. But the ones in America are the Moderna and the Pfizer vaccines, and they're the mRNA vaccine. There's another one coming up from Johnson and Johnson under their biotech company, Janssen, which makes a lot of rheumatology drugs, and they have the adenovirus vaccine. And also, the AstraZeneca one in Europe now; they also use adenovirus variants. So what we'll talk about the differences,

Lauren: Yeah, can you tell us what that means? mRNA, adenovirus? What do these things mean?

Dr. Yu: The mRNA virus, it's been studied for over 10 years now. But it wasn't quite successful all these years. Research takes time. In the very beginning, things don't work out, so it takes time. People are saying it hasn't been studied in animals; it did get studied in animals. And people say, oh, we're guinea pigs. You know what, we're not guinea pigs. It’s been studied in humans already, phase 1, phase 2, phase 3. Different phases mean different things. So phase 3, they usually do a test group versus a placebo group. That's what phase 3 is. It was in The New England Journal of Medicine, it was published with over 40,000 participants, I think Pfizer had that, and 30,000 Moderna … I might be mixing them up. But the data is right there. That's why you see a lot of doctors taking it because we see the data, we understand the data. And both of them had around a 94, 95% success rate. So if you look at the data, for example Pfizer … in the first couple of weeks, or the first week, you'll see that both the placebo and the vaccine itself, the people that got both, they both had still the same amount of COVID infectivity. But over time, you'll see that the placebo group and the actual vaccinated group start branching off. The vaccinated group get less COVID. And the placebo groups are still getting the COVID infection. But just because you get the COVID vaccine does not make you 100% immune to COVID. It just gives you a strong … like when you're getting the flu vaccine … just because you get the flu vaccine doesn't mean you're not going to get the flu … there's always a chance.

Lauren: But there's also a distinction there, isn't there, that, especially with mRNA, that with the flu vaccine, you're getting a bit of flu, and that's building your immunity. But mRNA is something totally different, right?

Dr. Yu: Yeah, the flu vaccine is a dead vaccine. So you're getting the coating of what the flu looks like. Your body sees that, and the next time it sees that coating, again, with the real flu, it will attack it with a stronger army. Your immune system is an army. The mRNA is a little genetic code that tells your body to do things. A myth that is widespread on the Internet is that this mRNA is gonna alter your DNA and your genetics. That’s not the way it works. mRNA is in a little something called a nanoparticle, so you get your injection, and the mRNA goes into your body, it sees your healthy cells, and the mRNA goes inside your healthy cells and then it tells your body's machinery to generate proteins. And that mRNA is that little code from the spike protein.

The spike protein is what the COVID-19 virus uses to attach itself to your healthy cells to hijack your body's DNA to replicate more COVID viruses, and that's where it takes over and destroys your body, potentially.

Lauren: So COVID can change your DNA? But mRNA can’t.

Dr. Yu: Yeah. COVID hijacks your cells to create more COVID viruses, that's what it does. That's what a lot of viruses do. It’s called a viral load when it goes higher and higher. So the mRNA is a piece of the spike protein that the researchers have discovered, the piece of the DNA that has the spike protein. And they code that and they take it and they put it into your cell. And it tells your body to create the spike protein. But there's no virus in it. It’s just spike proteins, and your cells show that spike protein on the receptors on the surface of the cell, and your T cells, your immune system, recognizes that. Your T cells, B cells … they see it and they start to generate antibodies against that spike protein. So your army in the future, when it sees that spike protein from the actual COVID, it's primed, ready to go to destroy the COVID virus itself.

Lauren: So that's an important thing for people to know, as well, that you can get the vaccine, but it doesn't mean that you can't get COVID. You might still get COVID, but you're more prepared to fight it. So your chances of survival are higher, essentially.

Dr. Yu: Yes, yes, that’s true. But there are side-effects with vaccines, there are side-effects with the COVID vaccine. Based on the studies out there, the COVID vaccine side-effects are very minor. Most people got maybe some fatigue, headaches, some joint pain, muscle pain, shoulder pain.

Lauren: Short-term. 

Dr. Yu: Short-term, a couple of days. Less than 1 to 2% got it. I got side-effects, I got shoulder pain. The first shot, I had less side-effects, just shoulder pain. The second shot was what really did me in. I got shoulder pain, I was really tired. And I also got some congestion, But you expect some immune response because your body has seen it once already, so it's ready to go and fight it again.

Lauren: Yeah, absolutely. Well, I'm so glad that you're getting vaccinated as well, because you're on the front line with these patients. I know we've gone on to a million topics, because it's so fascinating. But the trials here … has this thing been researched enough? It seems that the consensus that I've been sort of researching myself, through evidence-based resources, appears to be that we're hearing that it's in phase four, and it's being released to the public. But that it's actually that this fast tracking is the medical institution coming together to fight this global pandemic. And it's no faster or slower than any regular research phase. Is that correct?

Dr. Yu: Yeah. After phase three is when we start using these drugs, so you don't have to always go through phase four. The FDA fast-tracked this because we need it; it's a pandemic. Usually for drugs, fast is six years, but we're not gonna wait years, we already have the results. It's published already. So you don't have to be extra extra safe, requiring more studies, thousands more studies of the same thing. So it went through the regular phases a regular drug or vaccine would go through.

Lauren: And then what about this mRNA? And these different approaches to vaccination that you were talking about earlier? You've explained mRNA to us. What's the other one?

Dr. Yu: The adenovirus is just like another virus, one that can cause colds. That’s what they did for the AstraZeneca, and the one that's coming out from Janssen … AstraZeneca is being used in India and Europe now. So what it does is, it's very similar … they take the DNA from an unknown virus, but they found a way where part of that DNA can have a spike protein as well. So they push that into your body when they inject it, That goes into the cell and that DNA tells your cell to create mRNA. The mRNA will create that protein, which shows a spike protein on the receptors.

And the same process again … spike protein generates antibodies, so it's primed and ready to go when it sees the actual COVID virus next time.

Lauren: It can fight it. This is so fascinating, because it's like prep work you do before you cook, or the training that you do before you run the marathon. This is the stuff that sets you up for success when and if it does happen to you. You talk to us about receiving the COVID vaccine. I'm curious as well about whether you're recommending the vaccine to patients. Because you've got patients who are all over the map in terms of their personal risk. So what does that look like for you, especially with autoimmune patients? Because this is something where  … is there information out there for autoimmune disease patients, and the safety and efficacy of the vaccines?

Dr. Yu: The studies did not study patients with autoimmune disease or who were pregnant; they were excluded from the studies. Patients that were children, under 16, under 18 for Pfizer … they were excluded also from the study. So we don't have data on patients with autoimmune disease, us Spoonies, or patients using injectable medications. However, I tell my patients: still get the vaccine. Because getting COVID …

Lauren: That could be worse. I mean, that's really what we're talking about here. 

Dr. Yu: Yeah, I mean, chances are, nothing's gonna happen to you, right? Like the flu, chances are, nothing's gonna happen to you. I've seen or had people message me saying that they’ve flared from getting the actual COVID virus itself. 

Lauren: Ooh, not worth it. 

Dr. Yu: Yeah, I mean, there are followers that tell me they’ve flared from the vaccine itself. So it's a double-edged sword. And I have people ask me, can I get autoimmune disease from the vaccine? I’m, like, that's a possibility. Because there's something called ASIA syndrome (autoimmune/inflammatory syndrome induced by adjuvan). You can get autoimmune disease from vaccines.

Lauren: But from any vaccine, not just this vaccine.

Dr. Yu: Yes, from any vaccine, flu vaccine, hepatitis vaccine. It's rare. The benefits of vaccines always outweigh the risks. But it is a possibility, very low chance. That's something to be aware of. But the question is, do you want to get actual COVID and to risk it? Or do you want to skip the COVID vaccine and protect yourself? I chose the latter. I wanted the COVID vaccine.

Lauren: Well, you're around those patients, too. So it makes a lot of sense.

Dr. Yu: Yeah, chances of something happening to me is very low.

Lauren: So you're recommending it to all your patients across the board; it doesn't matter whether they're more high-risk, or they have more severe levels of disease?

Dr. Yu: If they're flaring, definitely not. The ones I recommend it, they're in remission, or very close to, or they're not actively flaring, just a little pain here and there — and that's fine. But all of us are very anxious and waiting for the data to come out on autoimmune disease patients, and the American College of Rheumatology will put out a statement sometime this quarter, talking about patients on these medications, us Spoonies.

Lauren: That's fascinating, because a lot of us are sort of waiting to see what the American College of Rheumatology will say about this. And it makes me wonder about … especially because the vaccine is not available to everyone yet, that's one factor … but also for people who are maybe working in hospitals — not necessarily doctors — but who have autoimmune disease and are working in the health field or exposed to people who haven't maybe been as circumspect about preventing the disease. I guess everyone can look at it on a case-by-case basis. But ultimately, what we're saying here is that getting COVID is far worse and the risks are higher than the short-term side-effects and the very low risk of additional complications from any of these vaccines.

Dr. Yu: Yeah, exactly. You hit it on the spot.

Lauren: I love that you've been so open with everyone about this information and gone and gotten the vaccine yourself and explained to people what you've been through with it. To sort of pivot back to your work … we've stayed away from COVID content on this podcast for a reason, because we're inundated with it, right. And this is the first time we're really addressing it, because this is something that's really important to our community. But I'd like to know a little bit more about your work, and how you're dealing with patients, in particular. Because, as you know, by the time a lot of patients get to you they've been gaslit, they've been told they're hypochondriacs, that it's all in their head. They've been told that the tests don't show anything. And they're probably shuttled from specialist to specialist. They're lucky if they end up with you first. So, does it make a difference in terms of the way that you show them a certain kind of bedside manner? Are you super aware of that in terms of dealing with your patients and offering additional empathy? I know you mentioned that you spend at least an hour with new patients, which is pretty exceptional. What does that look like for you?

Dr. Yu: ...

When patients tell me they have pain, I tell them that I understand their pain.

“Does it feel achy, does it feel this, doesn't feel like that … because that's the way I feel.” That's how I talk to them. I can emphasize, like when they tell me, “Oh, I have this pain,” I’m, like, “I know exactly how you feel.” So it's very, very easy to talk to patients. There are patients who come to me that have been shuttled around from doctors that don't hear them. But I understand there is something going on, it's not all in their head, it’s just that the doctor doesn't understand or that our scope of training hasn't allowed us to find a diagnosis. And there's so much at play here — gut microbiome, their environment. All these aspects — psych, trauma, all these things you have to explore — that can contribute to the current manifestation of that patient's problem. And I am seeing patients all over the US now because of this. I have 15 state licenses, I'm getting more. Because there's no one that's practicing like I do, so I'm trying to make myself available to these patients.

Lauren: So are you also offering all that testing … you can set patients up with gut microbiome testing and nutrition and mental health support? 

Dr. Yu: I do all that. I treat patients in New Jersey the same way as they'd be sitting in my office. I can do blood tests, I can do imaging, I can give meds and do all the questioning the same way; it's covered by insurance. I don't do the gut microbiome testing, because I don't need to. All autoimmune disease patients have a disrupted gut microbiome, and I know how to treat them. To me, I don't need to waste a patient's money by getting a gut microbiome test. So I don't do too much specialized testing. It's available to me, but I do what's most obvious, and what's most cost-effective for the patient.

Lauren: That’s really smart. Yeah, that's wonderful. And then are you also referring out to psychologists and therapists that people need? 

Dr. Yu: Yeah. So what's exciting is, my wife is also psychiatry trained. 

Lauren: Oh, my gosh, so you two are, like, hashtag goals!

Dr. Yu: Yeah! She did her one-year fellowship in psychiatry. So I do have patients who are working with both her and I, autoimmune disease patients. It’s so hard to find a therapist these days, and they need that extra TLC. She does mind/body medicine; she can manage the medication so I ship them to her. I'm still trying to find therapists. I have one or two, but they’re usually booked. So if you have any resources for me, I'm trying to have  a pool of different therapists.

Lauren: Oh, have I got resources for you!

Dr. Yu: Awesome! I need to create a resource guide for patients. My website, myautoimmunemd.com, is going to be a home for a lot of us Spoonies. And I'm not just talking about the integrative part, but also the traditional part as well. Because I feel like there's no side that's good or bad.

It's just tools in the toolbox for people.

Lauren: I love that. We've got a few minutes left, and I want to talk about the healthcare system, because we're touching on it here and there. I'm curious to know what your thoughts are. You mentioned that there's no right or wrong way. It's tools in the toolbox. But what are your thoughts about the healthcare system and how it's working for doctors and patients and helping foster that care relationship? And how it's working against that relationship, as well? What are the advantages and disadvantages of this health insurance and health care system that we have here in the US?

Dr. Yu: Let’s talk some of the good stuff first. The good is that the health care system is giving patients access to see a doctor. When they're sick, they can see somebody; when they're really sick, they can go to the hospital, go to the ER. So that's what's good about it. The bad part is, doctors are overwhelmed. Doctors don't have time to see patients for an hour. Especially when you're at universities or at a county hospital, you don't have that time. One doctor is managing sometimes thousands of patients at one time. Your doctor doesn't have time to respond to you after you see them, and email you; they don't have time to email you back because they have 20 other things on their plate. They’ve got families to go home to as well. So it’s unfortunate that our system's broken. And even if you're really sick, you cannot reach your doctor.

I've been through this as a doctor; I didn’t have time when I was training to get back to the patient.

And it's a for-profit system. So your insurances are the ones that are really profiting from this. Not your doctors. Your doctors are salaried, usually. If you see one patient, or 60 or 1000 patients, you get paid the same usually,

Lauren: And they're graduating medical school with mountains of debt.

Dr. Yu: Exactly. So it's really the insurance companies that are profiting off of this and you're paying what … $500, $600 a month. If you go out of network, you're paying extra. When you go to the hospital, you can’t choose your doctor sometimes or your specialist that comes to see you. If they are out-of-network, you get billed extra. And sometimes you want a certain medication and you can't get the medication, even if it’s the newest one or the best one — because the insurances want you to go for the cheapest one first and go through a process.

Lauren: Fail first.

Dr. Yu: Yeah, they want you to fail it first. So by the time you actually get to the one that works for you, it's probably half-a-year, a year already, and you're extremely sick. So this system is really broken. That's why I am out on my own. Because I get to practice the way I want to.

Lauren: What does that mean, though? Does that mean that you're working outside of the health insurance system? Because you mentioned that you get tests covered by insurance. But it sounds like your in-office fees are then separate?

Dr. Yu: Exactly. So I don't take insurance in my office; the only thing I take is Medicare. All the tests and imaging and medications, they go through insurance for patients. So the only time they’re paying is to see me, literally.

Lauren: What about patients who need financial support to access care at the level that you're able to provide it? Are you helping patients find pathways to fund that? Or are you able to offer a sliding scale for people? Because it’s hard! Those of us who are living with the burden of chronic disease are also living with mountains of debt. Because you have to fail first in so many instances. What does that look like for you?

Dr. Yu: Yeah, that's a great question. That's one I haven't explored yet. I literally opened my doors this past November. So I haven’t explored sliding scale yet. But I'm going to be coming out with courses in the future. I am offering free advice on social media all the time. 

Lauren: All the time. 

Dr. Yu: So yeah, unfortunately, right now, you're not able to get my one-on-one opinion. But I will be coming out with things in the future; I will be coming out with courses, guides that you can purchase, or my website will have blogs on there. It's all free. My social media posts are free. So you can go by that. And you can always find another doctor out there, and just show them what I give you, and then talk to them about it.

Lauren: And this is where it's so useful, even if you can afford a consultation, right? Like if you're early stage diagnosis, and you're not sure that you're being listened to, you could schedule a consultation to see you, take that information and bring it to another doctor and say, “Here are all the tests that I need. Here are all the things I want to look into.” And really work the system that way in that sense, right?

Dr. Yu: Yeah, you can do that.

But a lot of doctors will probably dismiss it, too, or they don't have time to listen to all the paperwork you're about to show them.

I always ask patients … you can either keep seeing the doctor getting the same treatment, or you can come see me, pay out-of-pocket and get something different and potentially get off meditations and heal.

Lauren: And you are off medications for the spondyloarthritis.

Dr. Yu: I am off medications. I do get some pain here and there. But that's from stress, or if I eat some processed food, that comes back a little bit. But nothing like the way I suffered back then. I do have patients in remission, off medications as well. It's very possible.

Lauren: It’s amazing. Are you also hoping that the model that you are creating and building right now is one that perhaps the for-profit interests in the health care system might eventually take note of and work to change their approaches so that they can better serve patients?

Dr. Yu: That's a hope. I am a pioneer in this space in rheumatology because no one is really combining medicine. But I don't see it happening. Because if patients are using that kind of care and they get better … the pharmaceutical companies won't be able to profit off your medications, because these medicines that patients in rheumatology are using are costing thousands of dollars, usually. And so the insurance companies want patients that are not too sick, but are sick enough where they need insurance as well. So it's a for-profit game, unfortunately.

Lauren: Do we have to disassemble it? Do we have to sort of burn it down to the ground, this whole for-profit interest? 

Dr. Yu: It's hard because the for-profit side is a double-edged sword. It fuels research, right? Most of the research permits coming up from the United States, the shareholders are gaining from it. And the pharmaceutical companies, once the shares go up, everyone's happy. So the money drives research. It’s capital.

Lauren: But we also see real disconnects, don't we, between the funding that goes into, say, AIDS research versus ME/CFS research, for example, right. We see these massive differences in what dollars are allocated. And that comes to a political level as well, doesn't it.

Dr. Yu: Yeah, it's political. It's hard. I don't think there's a perfect system. If you look at the Canada, UK, the insurance companies aren't really in play. It's more the government. But at the same time, it seems to me, if you have cancer or you have something, you're gonna wait sometimes months to see a doctor. Whereas here, you see a doctor quicker.

So I mean, it's not a perfect system that we're in, but at least it sort of works in a way. 

Lauren: Maybe universal basic income is the is the solution, because then people would have the money to actually fund their health care.

Dr. Yu: Possibly, yeah. And then if you want something special, you can go see doctors like me that are outside the system.

Lauren: But you're also in the system. Because as you say, you're calling for tests that are covered by insurance, too. So you're dancing with the system.

Dr. Yu: You’re paying for my time, that’s all.

Lauren: Yeah, well, and hopefully, you'll be able to train the doctors of the future as well in your own way, and really get the medical community to understand what needs to be addressed here and how we need to change our approaches in medical training.

Dr. Yu: I am part of the academic system in a way, because I am giving a talk to UC Irvine. 

Lauren: That’s a huge medical school. 

Dr. Yu: Yeah. At Loma Linda University, I gave a talk on this before I graduated. I am an associate professor at a medical school in Southern California. So in a way I'm trying to dance in this whole situation. Where I am doing integrative, I'm doing something that's not traditional, I do want to keep updated with the traditional system, I do want to have the respect. Because on the integrative side, sometimes doctors will call them quacks. So I'm in the middle. I believe that you can heal naturally. But I also believe in the power of medications. And really, it's up to the patient and their patient goal and the situation, and what tools we use in the toolbox.

Lauren: Well, and what's wonderful is that if a patient comes to you, you're looking at evidence-based solutions, you're looking at science. So that’s the thing that we can all look toward for answers, and that we try to do here on the show, too. Dr. Yu, iss there anything else that you'd like to share? Please share where everyone can find you to find your work.

Dr. Yu: My handle is @MyAutoimmuneMD on Facebook, Instagram, TikTok, Twitter, I dance on TikTok.

Lauren: I love it!

Dr. Yu:  I'm going to come out with my YouTube sometime this year and my website … sometime in February, my website’s gonna go live with blogs. And if you want to see me as a patient, just go to my website, DrLlifestyle.org. And you can email me there as well.

Lauren: Dr. Yu, it’s been such a pleasure talking to you today. There's so much more I want to know. I'm just so thrilled that our community has doctors like you who are responding to the needs that we have, so directly. And I wish you the best of luck in your continued healing and remission from spondyloarthritis. I'm a bit bowled over, I'm a bit overwhelmed — which doesn't often happen to me that I end up speechless! So all I can say is, thank you so much for all you do for the Spoonie community and we're so excited to have you as one of us.

Dr. Yu: Oh, you're welcome. Thank you so much for having this podcast, for being a voice for patients like me, and just to be able to bring on experts and patients onto the show to really show people that they're not alone. And also for supporting me, and having the Spoonie community supporting me as well. That means a lot to show that what I'm doing is worth it.

Lauren: Absolutely. I am so happy you're here.


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