Cupping - The Miracle Revealed

         I escape from work for an extended lunch hour.   It may be a bit irresponsible of me to turn off my pager and silence my phone in the middle of the day, but the reward is decadent - an hour of true relaxation.  Also, I don’t want anything to detract from my cupping experience.  The spa is located in a cozy cottage in the Montford historic district of Asheville.  Without GPS assistance, it would be nearly impossible to find.  As I enter, I am greeted by a diminutive blonde woman who will be my cupper – if that is the appropriate term.  She hands me the requisite form to list why I have come and to give my past medical history.  There is a line to indicate if I have any communicable diseases.  I pause and think of some cool diseases I might write down.  After a bit of contemplation, I decide to write “leprosy” on the line while enjoying a small chuckle.  I also note that I suffer from chronic lower back pain and bilateral shoulder tendonitis.

     When I have finished completing the form, she leads me into a small room with a massage table in the center.  She explains that the session will be an hour in length with some initial deep massage followed by cupping.  She asks what I hope to gain from the session.  I say that I would like to have two fully functional shoulders, relief of my back pain, and at least one Olympic gold medal.  She gives me a sideward glance and says, “Special Olympics maybe.”  She is a funny one.  Doesn’t she realize that humor is my shtick?  She then shows me the cupping machine, which is about the size of a bread box with numerous dials and gauges along with several tubes connected to glass cups.  Basically, it is a small vacuum device.  She says she will step out while I get undressed.  She indicates that I can fully disrobe or leave my underwear on.  I sheepishly opt for wearing my boxers.

       When she returns, I am safely tucked in face down between the warm sheets on the massage table.  For the next hour, my visual field is limited to the shadows and movements which I can see from the hole in the head rest.  She is barefoot with painted toenails – that is about all I know.  She tells me that she may be small, but that she will do her best to give me a good, deep massage.  “Think of me as a hefty Russian woman, rather than a small woman who weighs 100 pounds soaking wet,” she says.  While I lay there waiting to begin, she says, “I see you suffer from Leprosy.”  I laugh, forced to reveal my little joke.

        She dims the lights and turns on some soothing background music.  Then, she gets down to business.  She kneads warm lotion into my back and shoulder muscles.  I am in my happy place.  For the most part, I enter a zone of semi-consciousness.  She thoroughly works me over, from my shoulders down to my upper buttocks.  After about 40 minutes, she pauses and turns on the cupping device.  She applies the vacuum cups to my back and shoulder.  It feels like she only applies one or two at a time, but I am not sure.  The longer the cup is applied, the more intense the pulling sensation.  It feels like a strong vacuum cleaner being applied to my skin.  She alternates between leaving one or two cups in a single place while massaging a different region of my back – using massage as a distraction so that she gets me to relax areas I would otherwise naturally tense up.  She also uses the cups like vacuum cleaners, rubbing them up and down my back and shoulders with intermittent stays for a few seconds in different regions.  The cups create a little discomfort, but nothing too unpleasant.  They do little to jolt me out of my state of relaxation.  After about 20 minutes, she clicks off the machine, and we are done.  Prior to her stepping out the room, she tells me to take my time getting dressed.  She also encourages me to drink a lot of water throughout the rest of the day.  She also says I should expect to get a few stares if I go swimming or participate in group activities without a shirt in the next few days.  I pay 105 dollars, and after a little small talk, I am out the door.

        When I get home, I strip off my shirt and examine my back in the mirror.  I look like Michael Phelps, minus the big shoulders and V-shaped back.  A number of silver dollar sized bruises pepper my back.  I tell my kids I was mugged by a man with a baseball bat on the way home, and I am lucky to be alive.  They almost believe me.  They act concerned, but then I reveal the truth, and they again regard me with typical indifference.  They are used to my kidding.  I do look forward to showing off my marks at the pool. 

        Aside from the new experience, are my shoulders and back better?   Time will tell.  

 

 

Please check out my recently published book on Alternative Medicine.  It makes a great Christmas gift!

 

https://www.amazon.com/Are-You-Afraid-Snakes-Exploration/product-reviews/1935660268/ref=dp_db_cm_cr_acr_txt?ie=UTF8&showViewpoints=1

Cupping - I want to be like Mike

            Finally, my book on alternative medicine is published!   I tried every alternative therapy there is – or did I?  This past summer, after completing the final version of my book, edits and all, the Summer Olympics come on television.  And what do I see?  None other than the great Michael Phelps, ageless wonder and swimmer extraordinaire, covered with hideous red circles.  Has he been attacked by an army of leeches while swimming in the contaminated waters of Brazil?  No, I learn from the announcers, he is the latest disciple of cupping.  Not only does he go on to win a gold medal in the event I am watching, but he goes on to rewrite the record books as the most decorated Olympian ever.  Certainly, cupping is his secret.  As a result, everyone asks me if I have tried this ancient therapy.  When I say “no,” I can tell I have lost a potential reader.  What kind of alternative medicine book leaves out cupping?  I rationalize that cupping is “alternative” alternative medicine.   Alas, I learn that cupping is not just popular with Mr. Phelps, but that People magazine’s world’s most beautiful woman, Jennifer Aniston, along with Gwyneth Paltrow, Victoria Beckham and even tennis star Andy Murray are devotees of cupping.  Thus, despite having completed my book, my adventures in alternative medicine shall continue – I must try cupping.

            “What is cupping?” you might ask.  Cupping, a form of acupuncture, dates back over 5000 years.  It is reported that as early as 3000 B.C., the ancient Egyptians performed cupping. Hippocrates purportedly used cupping to cure internal disease around 400 B.C.  Later, cupping was embraced by the Chinese, and it continues to be popular in Asian culture even today.  The goal of cupping, which is achieved by creating vacuum pressure in cups applied across your body, is to draw out inflammation by increasing the local blood supply to the underlying muscles and skin, thus allowing toxins to be carried away.  These are two of my favorite alternative medicine themes – “inflammation” and “toxins.”  Reading further, I learn that both acute and chronic conditions can be treated by cupping.  How is cupping done?  There are various methods.  In one, cup-like pneumatic devices which create suctioning like a small vacuum cleaner are applied to the skin, while more traditional methods involve lighting alcohol on fire below a glass cup overlying the skin, creating a vacuum as the oxygen is gobbled up in the chemical reaction.

            Where does one go to get cupped?  A quick internet search finds cupping to be quite common in Asheville -  and I thought the multiple red circles seen on everyone’s back were just strange tattoos.  It just so happens that my wife’s favorite massage parlor, if anyone uses that phrase anymore, offers cupping.  I schedule an appointment for one week from today.  My visit is timely:  my lower back continues to pain me and my shoulder tendonitis has been acting up.  I am eager to see what cupping can do for me. If I can’t be rendered pain-free, perhaps I can at least win Olympic gold - just one will suffice.

Next week . . . my cupping experience.

To read more about my alternative medicine experiences, cupping excepted, check out my book on Amazon and consider making it a Holiday gift.

https://www.amazon.com/Are-You-Afraid-Snakes-Exploration/dp/1935660268/ref=sr_1_1?ie=UTF8&qid=1481243467&sr=8-1&keywords=are+you+afraid+of+snakes

           

Are You Afraid of Snakes - A Doctor's Exploration of Alternative Medicine - The book

I have finally finished recording all of my alternative medicine explorations in my newly published book:  Are You Afraid of Snakes?  - A Doctor's Exploration of Alternative Medicine.


In addition to the many topics I have discussed in my blog I also explore Hot Yoga, Craniosacral Therapy, and more.


Please consider ordering a copy on Amazon at:

<https://www.amazon.com/Are-You-Afraid-Snakes-Exploration/dp/1935660268/ref
=mt_other?_encoding=UTF8&me=>

Thank you for your support.


-Scott Mahan

Chronic Lyme Disease – Alternative Medicine Paradise

                   As I stated in my prior posting, Chronic Lyme Disease (CLD) is a controversial, yet not uncommon, diagnosis.  Generally, CLD refers to persons with symptoms lasting more than 6 months after a diagnosis of Lyme disease.  In reality, CLD has different definitions to different people.  For some, there must be a confirmed original diagnosis of primary Lyme disease while others assume CLD can arise without a prior tick bite, rash, or confirmatory testing.  Confused?  Me too.  Lyme disease has even engendered conspiracy theories.  Some have concluded that Lyme disease is a genetically-modified hybrid of syphilis that our government has weaponized. 

                Since doctors and alternative practitioners can’t agree on the definition of CLD, you can bet their approach to treatment will vary widely . . . and so it has.   Those of us who toe the party line of the CDC and the Infectious Disease Society of America disavow the diagnosis altogether.  CLD probably doesn’t exist, and even if it does, we haven’t found an effective treatment.  On the other hand, my colleagues in the Northeast, in the hotbed of Lyme, have often taken a different tack.  They are inundated with patients who have been bitten by ticks, have tested positive for Lyme, and still complain of joint pain, brain fog, and other assorted maladies despite having received the CDC recommended 14-28 days of antibiotics.  What to do with these patients?  Some stick to their guns and refuse treatment.  Others start to experiment.  Perhaps 14 days of antibiotics is not enough.  Maybe a different antibiotic will work better. The result is numerous regimens of long-term intravenous and oral antibiotics based on flimsy science.  What does one do when the patient demands treatment, but nothing is proven to work?  Often, trial and error rules the day. 

                I personally have seen patients diagnosed with CLD, despite never having a confirmed tick bite or having met the CDC definition for primary Lyme disease.  These patients have been placed on year-long courses of intravenous antibiotics, anti-fungals, and anti-tuberculous medications.  Often, the patients must then resort to anti-nausea agents to help them tolerate the complex medical regimen they are taking.  It is frightening.  It is safe to say many patients feel western medicine has failed them . . . so where do they turn?  How about alternative medicine?

                Naturopaths, herbalists, and homeopaths have stepped up their game to help the suffering CLD patients.   Special diets boost your immune system to help you combat the infection.   Diets tailored to boost one’s blood alkalinity have been proposed.  Astragalus drives the pathogens out of the lymph nodes making it easier for the immune system to attack; B-vitamins help damaged nerves heal; colloidal silver electrically zaps the bugs; and, of course, chlorophyll improves our oxygen absorption along with providing a safe amount of copper to make the body more toxic to pathogens.  This is only the beginning.  There are hundreds of herbal and homeopathic remedies to try. 

                The problem is that as crazy as all these remedies sound, I can’t do any better.  I suspect there is some underlying problem in persons diagnosed with CLD.  Perhaps for some, their symptoms are truly related to prior Lyme infection while others are suffering for an entirely different disease.  Until we know for sure, CLD will continue to constitute the Wild West of Medicine.  It is the Donald Trump of medicine . . . in the absence of proof; I can say and do anything I want.

Chronic Lyme Disease - Is it real?

               As an infectious disease doctor, I am constantly being asked about Lyme disease by my patients, acquaintances, and other doctors.  Their interest is well founded.  One only needs to Google “Lyme disease” to see the thousands of divergent opinions and theories, both by the medical establishment and the public.   Even my colleagues are confused.  What constitutes a true diagnosis of Lyme disease?  Can a person be infected by Lyme disease despite having a negative test?  Is chronic Lyme disease real?  I field these questions on a daily basis despite living in North Carolina where Lyme is a rarity according to the Center for Disease Control (CDC) and the N.C. State Health Department.  I am sympathetic to my colleagues in the Northeast where Lyme disease is endemic.  I, for one, will not be volunteering to practice medicine in Lyme, Connecticut.  Despite my relative insulation from the heat of battle,  I am fearful that with global warming and the associated intrusion of new vector borne pathogens into traditionally cooler and less bug infested areas, the Lyme referrals will increase, even here in the N.C. Mountains.  What is a clinician to do?

                First, let me relate what is known about Lyme disease and generally accepted by most clinicians - both western trained and alternative.  Lyme disease is the most common reportable vector born disease in the United States.  Lyme disease is transmitted by certain ixodid ticks and is caused by the spirochete Borrelia burdorferi.  Lyme is also present in other countries where other Borrelia species may be involved.  According to the CDC, over 30,000 cases of Lyme are reported in the U.S. each year, although the true number of cases likely exceeds 300,000 due to underreporting.  Classic early Lyme disease presents as a bull’s-eye rash that appears 1-2 weeks after a tick bite.  For some, the rash is all they get, but others may report fatigue, headache, joint pain, and occasionally, fever.  Early Lyme is treated with antibiotics, usually doxycycline.   Serologic testing at this point is not recommended, as an immune response has often not yet kicked in, leading to falsely negative tests.  Up to this point, there is generally agreement, but with all else Lyme, the consensus breaks down.

                The problem is that despite a clear CDC definition for Lyme disease - a reported tick bite and classic skin lesion for early Lyme disease, and well defined serologic criteria for secondary Lyme disease- there is ambiguity regarding whether people commonly progress to long term symptoms related to Lyme disease despite treatment, an entity referred to as chronic Lyme disease.  Some argue that a person can develop chronic Lyme disease despite never having a distinct tick bite, rash, or serologic evidence of infection.  An expert panel organized by the Infectious Disease Society of America (IDSA), the main association for infectious disease doctors in the U.S., agrees a percentage (upwards of 20%) of persons with confirmed Lyme infection may continue to have persistent complaints lasting beyond 6 months from the original diagnosis despite appropriate treatment, but asserts that the complaints and numbers affected are not significantly greater than the general population as a whole, and are thus not clearly attributable to Lyme disease.  Additionally, the panel has concluded that even if there is such an entity as chronic Lyme disease, which it says there is not, there is no evidence supporting treatment with a longer course of antibiotics or any of the treatments proposed to date.  Here is where the IDSA is at odds with other Lyme advocacy groups and Lyme societies.   The International Lyme and Associated Diseases Society (ILADS) has reviewed the same studies and formed entirely different conclusions.

                What is a clinician to do?  The patients are confused, the doctors are confused, and I am confused.  Something must be going on, but what?  Patients complain of “brain fog,” poor memory, numbness, pain, headaches, and irritability.  It sounds like a bad hangover.  While all this suffering is concerning, it does create enormous opportunity.  Into this knowledge gap, many have entered.  In the Northeast, Lyme Clinics abound.  It really feels like the wild west of medicine.  There are endless remedies proposed and no lack of willing customers.  Cures for chronic Lyme disease are offered by dedicated western trained clinicians, opportunistic western trained clinicians, homeopaths, herbalists, and alternative practitioners of all stripes.  

Stay tuned.  Next post -  Chronic Lyme Disease - Alternative medicine paradise  (The next post will be in 2 weeks – I am gone to Nicaragua for a medical mission in the interim)

Chiropractor- The return visit

A week has passed and it is time for my return to the chiropractor.  I am not so crippled as I was, but my back still feels “weak.”   What do I mean by weak?  I still have a deep uneasiness that stems from my lower back.  It gets sore when I sit or stand too long, and it feels like I am just an awkward bend away from full disability- Medicaid here I come.  Hopefully, today’s visit will help my back regain its stability.

                 Today’s visit has an added bonus.  Included in my $25 co-pay is a 20 minute massage.  I am introduced to a 40 something year-old masseuse who invites me back to his room and massage table.  He has me lie face down  while remaining fully dressed.  I am a bit bummed that he doesn’t at least have me strip off my shirt.  I rightly assume  this means no massage oils, and a limitation to the deep probing.  Despite this he quickly identifies the tight muscles up and down my spine. He spends the allotted 20 minutes probing and massaging my neck and back.  It is quite satisfying. Once I am loosed up to his satisfaction he sends me over to the chiropractor.

The chiropractor wastes no time. After a quick consultation of my x-rays taken last week, and a few perfunctory questions, he gets down to business. Mercifully, he again forgoes cracking my neck (the maneuver which seems most likely to cause paralysis).  Despite my having had a massage, he uses a handheld vibrating machine to tenderize my back muscles a bit further, and then has me lie on my side with my upper leg bent up as he adjusts my back by pushing down quickly on this leg. He elicits a satisfying pop and he is done.  It is a short, but satisfying visit.

Over the following week I note continued improvement in my back. Each time I run it causes a bit of a setback, but by and large I get better. No more radiating pain.  I also start to do more stretching.  I read that exercise – of almost any kind- is the best approach for lower back pain.  http://well.blogs.nytimes.com/2016/01/27/to-prevent-back-pain-orthotics-are-out-exercise-is-in/?_r=0

                Regular exercise it will be-  a bit less running, but more swimming, biking, and definitely yoga.  Does chiropractor care make a difference?  The jury is still out.  My prior research certainly did not find overwhelming supportive evidence for chiropractic care. I will probably return when I have flares of my back pain based on the notion that something is better than nothing. 




to see my prior conclusions and evidence review:
http://alternativemeddoc.blogspot.com/2011/07/chiropracter-my-final-analysis.html

Chiropractor- It must be my leg

           It is just three days since my visit to the chiropractor and I must admit my back is considerably better.  I no longer have pain radiating from my lower back down my left buttocks. My mobility is much improved. I am now able to tie my own shoes, much to my wife’s relief.  I am even able to drive my son all the way to Athens, Georgia for an ice hockey tournament.  I am not sure if the improvement in my back is related to my chiropractic visit, or if it is just the fact that is now two days further from the time when I strained it.  Regardless of the reason, I am not complaining.  It does make me eager to see the chiropractor again next week.

                I want to address the root cause of my back problem.  Perhaps it really is due to my left leg being shorter than my right leg. I have been told this by two chiropractors and a physical therapist. Previously, I was prescribed a heal lift which I never picked up. I decide to address the leg length discrepancy myself.  I dig into the inner recesses of my closet to find the orthotics that I was given several years ago for plantar fasciitis.  Rather than place them in both of my shoes as the podiatrist had recommended for plantar fasciitis, I decide to wear one in my left shoe only.  It feels a bit odd at first; like I am a bit cock-eyed, but after a while I adjust my gate.  It is not until around noon that I realize I have put the right foot orthotic in the left shoe. Duh.  A neurosurgeon I am not, of course Ben Carson is a neurosurgeon…Hhmm…  I wear the appropriate orthotic in the left shoe the remainder of the weekend, but by Monday I decide to abandon it  until my legs have been properly measured.   When my wife, Beth, finally helps me measure my legs we find they are the exact same length.  Amazing, my left leg must have had a growth spurt over the weekend.  

On further appraisal of the situation, I think the interpretation of standing films of your back and pelvis is deceiving.  It is not surprising one side of my pelvis might be higher than the other when my back muscles are rigid.  Additionally, most of us don’t stand perfectly straight- hence curvature of your spine and pelvis tilt. This seeds doubt in my mind regarding chiropractors. Nevertheless, I plan to return to tomorrow, and I am looking forward to the visit. The healing of my back appears to have slowed, undoubtedly hindered by my runs with my son, David, over the past couple of days.