Acupunture: The final analysis.

First, let me acknowledge I did not give acupuncture a fair shake.  I only attended two sessions with two different practitioners to boot.  I have already been accosted by several of my wife’s friends who have offered testimonials regarding the benefits they experienced with acupuncture.  It is recommended that one receive multiple treatments, at least weekly at the beginning, if one wants to achieve positive results.  Alas, I admit I have not done this and will not be doing this.  I can handle a degree of pain; I can force feed myself handfuls of pills; I am willing to foot a large bill; I am even willing to eat vegan; but, I can’t handle overwhelming boredom ….  this is what acupuncture offers me.  The needles were relatively painless (see prior entries for the exceptions), and the practitioners appeared competent, but the chore of lying completely still for up to 45 minutes at a time is beyond my capabilities.  By nature, I am too fidgety and curious to lie motionless when I am chock full of needles, doing my best imitation of a pin cushion. When my hand and wrist were impaled with needles, I was unable to overcome the desire to see how far I could move my hand without feeling searing pain.  The answer - not far. When I explain this to my wife, she just rolls her eyes and treats me as if I am her 4^th child.

            What about those meridians?  Purportedly, a team of Korean researchers in the 1960’s used advanced “microdissection” techniques to look for actual anatomic structures in the body which correspond with these traditional acupuncture pathways.  They claimed to have found a series of fine ductlike tubes with fluid sometimes draining in the same direction as and at times in opposition to known lymphatic and blood channels.  More recently, researchers have used MRI’s and electromyelographs in attempts to confirm that the meridians and acupoints have a biologic basis.  The results of these studies are confusing at best.

            What about clinical results?  Acupuncture is claimed to be effective for problems ranging from drug addiction to pain management during surgery.  I started by Googling surgery and acupuncture.  I ended up viewing an incredible video of an abdominal surgery performed in China on a man using acupuncture alone rather than anesthesia.  The video was a bit grainy and the camera angles led me to question if I might be getting scammed, but apparently, he tolerated the surgery.  Aside from numerous testimonials, I was unable to find any real proof acupuncture is a viable option for surgery.  Next, I looked for articles supporting acupuncture for the treatment of back pain.  I found a well-done randomized trial in a respectable journal, The Archives of Internal Medicine, which compared 4 regimens for chronic low back pain: 1) an individualized acupuncture regimen, 2) a standardized acupuncture regimen, 3) a sham regimen, and 4) a non-acupuncture usual care group.  The findings… the first 3 groups all had similar decreases in their perceived level of dysfunction.  All 3 of these groups, which also included the sham group, felt significantly better than the usual care group.  The authors’ conclusion was that tailoring needling sites and penetrating the skin appeared unimportant in eliciting therapeutic benefits.  The likely conclusion is the patients were largely experiencing a placebo phenomenon.  To be fair, I decided to include findings from the journals which focus on complementary medicine rather than just traditional medicine. This led me to a review article published in the Journal of Complementary Medicine in 2004 which concluded “international agreement has emerged that acupuncture appears to be effective for postoperative dental pain, postoperative nausea and vomiting, and chemotherapy-related nausea and vomiting.”  Beyond this, acupuncture was found to be at best “promising” for some conditions, “inconclusive or difficult to interpret” for others, and of no benefit for smoking cessation or weight loss. 

            What are my conclusions?  I have none.  I know that most of you probably consider me the ultimate skeptic, unwilling to give any “alternative” medicine a fair day in court.  I did expect the literature would have more clear evidence that acupuncture works.  Despite this, I am willing to keep an open mind and possibly try acupuncture again in the future.  China is a big country.  Who am I to argue with over a billion persons?  I don’t see myself ever using acupuncture for surgical pain, but maybe, just maybe, I might try it again for my recurring headaches.  

[Next week, there will be no installment. I will be taking a brief interlude from writing as I gather more material by experiencing new “alternative” approaches to medicine! Thank you for following, and please tune in again. ]

Acupuncture: A second try.

          Ultimately, I canceled my return visit to see the first acupuncturist, Dr. Lin.  As a result of my first visit, I had an intense headache that took days to resolve, and my back pain was unchanged.  Mainly, I could not imagine lying motionless again for 45 minutes with nothing to distract me but the ticking of a clock.  Instead, I scheduled a visit with a nearby acupuncturist who I located on-line.  It just so happens her office is located in the same building as my Naturopath.  This only deepens my suspicion that all alternative medicine practitioners are in cahoots!

            Dr. Jones had clearly just relocated to this newly renovated office space.  I will refer to her as Dr. Jones, although she really doesn’t appear to have a doctorate that I am aware of, nor does Dr. Lin.  The office is clean and spartan.  Again, there is no receptionist, and the walls are barren of pictures.  Dr. Jones appears to be a nice woman in her mid-40s.  She leads me into one of the two treatment rooms, and I am relieved to see a boom box in the corner and no large clocks on the wall.  I am hoping music will help the session pass by more quickly.  Dr. Jones spends 15 minutes taking a thorough history.  She inquires about my headaches, back pain, sleep habits, and dietary habits. She asks whether I drink 8 glasses of water a day.  I hate this question.  No one knows where this old adage comes from, but it is a myth that continues to be perpetuated by all health care providers.  Yes, it is important not to be dehydrated, but drinking beyond what your thirst requires generally just means more urine.  Next thing you know, we will all be told we need 8 bottles of Evian each day!  She then measures the pulses in my wrists and hands by palpating 3 separate points on each limb.  She says she is not concerned with my heart rate; instead, she is appreciating the quality of my pulses.  She is intrigued by the pulses in my left hand.  She says my pulses suggest I have “sleep difficulties.”  She then examines my tongue.  I proudly point out that I have not brushed my tongue today because I had read not to do so in one of my books.  She gives me a half smile.  I wonder if I have bad breath.

            She has me lie face down on the table and inserts needles along my neck, mid-back, legs, and ankle region.  Nothing painful.  She puts on some relaxing music, dims the lights, and steps out.  This time, I actually do come close to falling asleep.  After 25 minutes she returns, removes the needles, and has me lie flat on my back.  This time, she inserts needles in my wrists, between my thumbs and index fingers (here I feel a short stabbing nerve pain, but it quickly dissipates), and several around my knees and ankles. She steps out again.  I find it much harder to lie still this time.  I find it almost impossible not to wiggle.  After a while, I try moving my arms, and I am rewarded with a quick searing pain.  “Must lie still,” I tell myself.  Boy, am I bored!  After about 5 hours (actually 25 minutes), she finally returns.  The needles come out, and I am done.  At this point, it dawns on me that I cannot return for more!  Blog be damned, but I can only take 2 of these acupuncture sessions.  Watching golf on television, playing tennis with my four-year old, and reruns of the Lawrence Welk show all pass time faster than these visits.  I, of course, do not tell this to the doctor.  I will have to email or call back and cancel the scheduled follow-up.

          Payment is a bit awkward.  Dr. Jones informs me she only takes cash or check.  I never carry checks and only by the grace of God do I have any cash.  My wife had actually put some money in my wallet that morning.  Unfortunately, I only have $50 and the fee is sixty.  She is unfazed and pockets the money.  I sheepishly offer to bring by a check for the remainder, but she states, “You are good for it. You can just pay me at your next visit.”.... I will be mailing it in.

[Next week, Acupuncture: a final analysis]

My most recent brush with mainstream medicine: Flu vaccines for the kids

    

        I must first be very clear and state that I believe in vaccination.  The benefits of vaccination far out weigh the risks.  Do persons occasionally develop vaccine-related side effects?  Yes, but the likelihood of any major complication is vanishingly small.  This is little consolation for those one in a million instances where a major side effect does occur, but it is the truth.  There is no relationship between autism and vaccination.  This proclaimed relationship has been effectively debunked.  Is there mercury still in some vaccines?  Yes, some flu vaccines still use very small doses of thimerasol, a mercury containing preservative.  Is there any proven or even suggestion of an association between these vaccines and autism or other health problems?  No.  There has been a growing undercurrent of persons refusing to be vaccinated or to have their children vaccinated.  In my opinion, this is foolhardy.  Clearly, these people have never seen a case of measles, mumps, or the complications of chickenpox.  Needless to say, my wife, my kids, and I always get the recommended vaccines.

On Thursday of this week, I opened a few bills which just happened to be from my hospital.  Beth had taken our 3 sons for a drop-in visit with the nurse in early January to get the recommended flu shots.  All three received the inhaled nasal vaccine administered by the nurse.  They were in and out after just a few minutes.  We thought little more about the visit.  All tolerated the vaccine, and no one came down with the flu that winter.  It is now 8 months later…when I opened the bill for this encounter, my jaw dropped.  The hospital had billed our insurance company $195 for each child!  This included an $84 charge for a less than 5 minute clinic visit with the nurse, $27 for a “therapeutic service,” presumably holding the nasal inhaler to each child’s nose, and 84 more dollars for “pharmacy” costs.  The insurance agreed to pay a somewhat lower amount, but denied the $84 “clinic visit” cost outright.  Ultimately, this $84 per child was billed to us by the hospital.  $252 out of pocket for 3 flu shots!  Not only was I irate, but I was extremely embarrassed to work at an establishment which could even consider this being appropriate.  We could have taken all 3 children to the local Walgreen’s down the street and had each immunized for $20 apiece, tops.

Needless to say, I called the toll free number for “Questions about your bill?”  I immediately identified myself as a doctor and employee of the hospital, and asked to have my bill reviewed.  The first woman I spoke with was only able to parrot the charges listed on the bill back to me.  She confirmed that I in fact did owe $252.  After I expressed my frustration, she connected me with her supervisor.  The supervisor was sympathetic and she said that she too would be shocked by such a bill.  She said she would look into the matter and get back to me.  Four days have passed and I am still waiting.  I am hopeful she will eventually get back to me with the matter resolved, and by “resolved,” I mean that I owe no money, but we will see.  The larger matter is that experiences like this, and we all have had them, add to one’s disillusionment with “modern medicine.” Why do my employer and I both spend hundreds of dollars a month for my health insurance if I get screwed in the end?  It is no small wonder that millions of persons in the U.S. and worldwide have said enough is enough and have sought alternatives for their medical care.  While the costs may be fully “out of pocket” when seeing most alternative practitioners, at least you have a better idea of what you are paying for.  I am not yet condoning any “alternative” modality over traditional care, but I am still early in my journey and I can’t promise what my final conclusion will be!  Nevertheless, I will continue to get my children and myself vaccinated even if it means a few inconveniences.

[Next week, a new acupuncturist]

Acupuncture: My first experience.

            Dr. Lin’s office is located on the second floor of a non-descript office complex.  I open the door of her office and am greeted by an empty room with two chairs against one wall and a desk against the other.  There are two closed doors in the back of the room which lead to two small exam/treatment rooms.  There is little indication that I am in the right place - no visible medical texts, no fliers advertising herbal products, nothing.  I sit down and after a brief period, Dr. Lin, a short Asian woman frocked in a white doctor’s coat, exits one of the two exam rooms.  It appears to be a one woman operation - no secretary, no assistant, just Dr. Lin.  Based on a the set-up and a single poster on the inside of the entrance door, I get the impression the office space is at times shared with a massotherapist who specializes in “hot rock” massages and similar therapies, but at the moment, Dr. Lin appears to be practicing alone.  A second later, an elderly woman in her mid-60’s comes out of the exam room.  By eavesdropping on their conversation, I surmise that she has been receiving treatment for sciatica, comes to see Dr. Lin on a regular basis, and is quite pleased with the results.  Dr. Lin practices a fee for service business which requires payment at the time of services rendered.  The woman pulls out her credit card and pays Dr. Lin on the spot.  The price is $85 for an initial visit and $75 for subsequent visits.

            After the woman leaves, Dr. Lin turns her attention to me.  She has me fill out a one page form describing my complaints and demographic information.  She briefly has me describe my headaches and my lower back pain.  That is about it - minimal history and no physical exam.  While reviewing my intake form, she notices that I am a doctor which seems to surprise her.

            She then leads me into one of the treatment rooms.  The room is sterile in appearance.  There is an exam table in the middle of the room, an acupuncture poster on the wall showing the 12 meridians, and a counter with needles, cotton balls, alcohol swabs, and other medical equipment.  I feel a bit disappointed.  In picking a doctor from China who is trained in traditional Chinese practices, I had expected a more oriental flare. I had thought the doctor would be dressed in a kimono and that there would be oriental music or the sound of a babbling brook present.  I expected the smell of incense to be wafting in the air and for the doctor to supplement her treatment with herbal remedies. Alas, none of this is present.  Rather, Dr. Lin seems to have adopted a more mainstream approach.  At least I feel rather confident that the needles will be clean!

            Dr Lin has me lie down on my right side with my shirt pulled up to expose my back while I face a large clock on the wall.  It is one of the big round clocks with a white face and black numbers which adorn the walls of classrooms.  Dr. Lin places the needles, about 15 in all.  She first places several needles over my temples, my ears, forehead and scalp.  I try to stay very still and as a result, I am not able to fully visualize the process.  It feels like she inserts the needle and then flicks it to push it in further.  It causes minimum discomfort, except for tightness around my scalp.  She then places several needles along my mid and lower back.  These are painless.  She next places a needle right in the middle of my left calf.  Ouch!  I feel this one.  It sends a shooting, nerve-like pain along my calf. It quickly subsides, but I feel a bit uneasy.  She next places several in the tops of my feet and ankle, but fortunately, she leaves the bottom of my feet alone!  She appears to be about done setting the needles.  She looks up and surveys her work.  “You are sweating,” she says.  I think to myself, “Of course I am sweating, you idiot.  I am a human pin cushion.  I can’t move for fear of stabbing pains!”  Instead, I answer, “It’s just my nature, I always sweat a lot.”  She asks if I am hot.  I say that I am fine.  She places a heat lamp next to my back.  Now, I am hot.

Dr. Lin places a small bell in front of me which I am to ring if I need assistance. She says she will be back in 30 minutes and that it is okay for me to fall asleep.  I say, “okay” and she steps out.  Of course, it is more likely that pigs will fly or that I will vote for Sarah Palin before I will fall asleep!  By nature, I am a wiggler.  My friends call me the “Princess and the pea” because I need perfect conditions to sleep.  I generally roll from side to side every 5 minutes for 30 minutes to an hour each night before finally nodding off.  No way am I sleeping now.  I can feel the tightness in my scalp from the many needles and a slight discomfort emanating from my calf.  Will I be able to lie still for 30 minutes?  I find myself staring at the clock. “Tick, tick, tick.” The minutes slowly pass as the clock provides the only sound in the room.  After an eternity and I mean an eternity, she finally returns.  She asks, “Do you still have a headache?”  I hesitate because I actually have developed a much greater headache than when I came in.  “Not sure?” she asks.  I nod.  “Let’s stimulate you a bit,” she says. She then proceeds to wiggle each needle in my scalp and in my back.  I feel only a minor twinge as they are jiggled.  She then steps out again.  Another eternity seems to pass. Now, I am not even sure when she will be back.

Finally, my curiosity gets the best of me.  I must see what I look like.  I cautiously raise my head up to try to look at my feet and legs.  I am stopped abruptly by a sharp pain in my back.  Quickly, I lie back down.  My muscles are now tensed and I am sweating profusely.  I wonder if I have undone all the possible benefits.  After 15 minutes, she returns.  She extracts all of the needles while dabbing at the puncture sites with alcohol.  She asks if my headaches usually start in my temples.  I concur.  She suggests that she bleed me a bit. (Have I returned to the dark ages? Wasn’t Abraham Lincoln’s death hastened by a good bleeding?) Of course, I say nothing.  She takes a small instrument and stabs me over each of my temples followed by some pinching and pressure.  It takes a few minutes and I am left with a red dot on each side.

            Then, she is finished.  She suggests I return within 1 week.  She says the treatments should provide longer and longer periods of relief with each treatment.  I fail to tell her that I now have a sizeable headache and my back feels unchanged.  Despite this, I go ahead and arrange a follow-up visit for the following week.

[Next week, a pitfall of western medicine.]

Acupuncture: Anticipating the visit.

I will next delve into the field of acupuncture.  Acupuncture originated in China over 5,000 years ago.  It is based on the belief that there is a vital life energy called “chi” present in all life forms.  Chi circulates along 12 major energy pathways called meridians. These meridians are linked to specific organs and systems.  There are purportedly over 1,000 acupoints along the meridians which can be stimulated to enhance the flow of chi. Needles can be inserted into these acupoints for pain relief and to restore health. Acupuncture is used to treat a long list of conditions including both acute and chronic pain, addiction, mental disorders, and infertility.

            When I went on-line to investigate if there were any acupuncturists nearby, I was amazed to find over 40 sites in the Cleveland area.  That seems to be a lot of needles being stuck in people!  Apparently, acupuncture has caught on in a big way.  Before we get too far in this new endeavor, let me come clean… I must admit that this whole concept of “chi” sounds wacky to me.  I don’t remember coming across these meridians when I was dissecting my cadaver in anatomy class.  Despite my skepticism of “chi,” my perception is that acupuncture must work for some people.  I have heard enough testimonials of major surgeries being done using only acupuncture, rather than general anesthesia, that it seems to clearly do something for some people.  The question I have is: will it do anything for me?

            I have an appointment scheduled for this afternoon, and I must admit that I am a bit nervous about this one.  Despite being a doctor, I am not a fan of needles, knives, or anything sharp which can cause pain.  My wife, Beth, can attest to this.  She loves Quentin Tarantino movies, including “Kill Bill.”  During this particularly gruesome movie which insists on following the entire path of every blade, I cringed during every swing of the sword and the accompanying severing of appendages.  Eventually, I had to stop watching due to nausea.  On top of my squeamishness of needles and knives, I don’t like anything touching my feet.  My kids know this all too well and are always sneaking up on me and grabbing my feet when I am lying flat.  I am mortified that the acupuncturist might actually stick a needle somewhere in my foot.  From my research, this seems to be an all too likely possibility!  According to a drawing in my reference book of the >1,000 acupoints, the feet have more than their fair share!

            Despite my fears, I decided that if I am going to try acupuncture, I will do it right. Rather than see a granola-eating, hippie, Asian wannabe, I will try the real deal.  It seems that if acupuncture comes from China, than I should go to a practitioner from China.  I find a Dr. Z Lin (name changed for my protection-nobody wants a mad Asian woman with needles coming after them!) who received her training at the Academy of Traditional Medicine in Beijing, China.  She reportedly comes from a long lineage of traditional Chinese medical doctors and began to learn her trade as a teenager under the tutelage of her mother.  Her website (yes, she has a website) has a long list of maladies which she treats including gastrointestinal disorders, gynecologic disorders (here is one I don’t have!), respiratory disorders, headaches, back pain, allergies, addictions, anxiety, and shingles.  This seems like the right place for me.  I decided I will ask her to focus on my headaches and back pains which amazingly are still nagging me despite my visits to a naturopath and a chiropractor.  I gave Dr. Z Lin a call, and I am able to make an appointment within a week.  A week has passed and today is the day!

[Next week: The initial visit.]

The Chiropracter: My final analysis.

Two weeks have passed since I wrenched my lower back, and just two days since my final visit to the chiropractor.  I must admit that my back pain is considerably better!  I still have some slight discomfort and tightness, but it is almost back to baseline.  The last time I strained my back, I was an invalid for over 6 weeks.  I am not sure to what I should attribute my rapid improvement.  Was it due to Dr. D?  Was my back strain less severe this time?  I am not sure.  I do know that it is great to be feeling better.  This seems to be a good time to examine the evidence behind some of the techniques and claims asserted at my chiropractor’s office.

         First, let’s analyze the advertisement for Estronex which is posted throughout the chiropractor’s office.  Now I know this is not, strictly speaking, related to “chiropractic” care, but I do think the things a practioner chooses to promote reflect on the type of medicine he or she practices.  This test claims to help determine a women’s risk for breast cancer by measuring the levels of various “good” and “bad” estrogen metabolites in her urine.  The web site for this test suggests that certain imbalances in these levels are associated with an increased cancer risk.  It goes further by saying that through dietary changes, these imbalances can be corrected.  It references two studies to support these claims.  I found both of these articles.  The first thing that struck me was that both articles are authored by employees of the company which makes Estronex.  This is a major conflict of interest, and in my mind means that any conclusion by the authors needs to be taken with a big grain of salt.  The articles themselves are merely reviews rather than research articles.  The larger review article espouses the urine estrogen metabolite test to “determine one’s 2/16a ratio [for] . . . determination of cancer risk…”  The same article, however, admits that “no conclusive data has yet to be published showing cancer incidence falls when individuals are treated with interventions that raise the ratio…”   The Estronex test appears to be a waste of money, and it makes me question the professionalism of the chiropractors who willingly advertise and provides such a baseless test to their female patients.

            The second claim I felt compelled to investigate was the “before” and “after” MRI pictures for spinal decompression therapy.  I found these claims difficult to stomach.  If such a miraculously effective non-invasive procedure existed, why was this previously unknown to me?  If this simple procedure could really resolve a herniated disc, I would be shouting it from the mountaintops and leading the millions of people who suffer from sciatica to the Promised Land.  I suppose you detect my cynicism.  One theory regarding the possible mechanism by which decompression works is that traction on the spine lowers intradiscal pressure thereby allowing a herniated disc to return to its normal position.  On the internet, I quickly found a scathing repudiation of spinal decompression.  One doctor documented (with references) 10 pages of anti-decompression evidence.  He points to a study in the 1980’s that showed intradiscal pressure actually increased with traction as the back muscles contracted to resist the traction.  It appears that traction might decrease back pain, although there is no evidence that it is superior to any other intervention. A recent review published in the journal Chiropractic and Osteopathy by Dr. Daniel in 2007 concluded, “Only limited evidence is available to warrant the routine use of non-surgical spinal decompression, particularly when many other well investigated, less expensive alternatives are available.”  I could find no well-done studies that substantiated its use.  This all jibes with my conclusion that although spinal decompression feels good and intuitively makes some sense, in the end, it has no clear benefit.

            Despite not agreeing with some of the claims and techniques which my chiropractor used, I must admit that I still found some merit in my visits.  In general, he and his staff provided a lot of “hands-on” attention.  Second, I liked the fact that adjustments, spinal decompression, and the prescribed physical therapy are all pro-active attempts at getting me better, unlike an internist’s technique of prescribing medicines to alleviate the symptoms.  I must admit I am not sure if the chiropractor made a difference, but I am feeling better and I do feel that chiropractors remain a reasonable option for the treatment of back pain.  I suspect that much like traditional physicians, there are good and bad chiropractors.  Mine was just okay.

[Next week, Acupunture]

Chiropractic care: A visit to his physical therapist

     Only 3 days have passed since my most recent chiropractic adjustment.  Today, I have an appointment with the physical therapist.  My back feels no better.  I wonder whether it might be a little too early to begin physical therapy.  I threw my back out only 10 days ago; my lower back is as stiff as ever; and, I still have to lie on my office floor between patients.  I am reassured by the fact that I don’t have radiating pain into my legs.  I suppose this means my discs are in place, and my spinal cord is not being pinched.  I decide it is better for me to not think like a doctor and instead, put my faith in the chiropractor.  I remind myself that the purpose of this endeavor is to give alternative therapies a real shot, even when they run contrary to my own preconceived beliefs.

            I meet with Sam the physical therapist.  I am prepared for a grueling work-out. Despite arriving in my work clothes, I have brought shorts and running shoes to change into.  Sam tells me there is no need to change.  I am disappointed.  I came ready to work this back problem away.  It appears my expectations for this visit were a bit misguided.

            Sam reviews my history and does a basic exam.  Primarily, he observes me bend over and attempt to touch my toes, and he watches me walk.  Surprisingly, he comes to the same conclusion as Dr. D.  My left pelvis is higher than my right.  I have never had so many people interested in the alignment of my pelvis!  Rather than suggest a heel raise, he thinks the imbalance is due to tightened hip flexor muscles which he believes he can improve with a few maneuvers and some exercises/stretches done by me in my spare time.  He takes me through multiple maneuvers, not unlike those performed by the chiropractor.  He pushes deeply in my left groin to the point of moderate discomfort.  In the end, he seems satisfied that my pelvis is less tilted (somehow he has managed to lengthen my left leg by over an inch, or so it seems).  He thinks that if I follow his prescribed exercises and stretches, I should do well.  He completes the visit with a 10 minute ultrasound treatment on my lower back.  The ultrasound generates a penetrating heat which helps my back muscles relax.  I leave with a regimen of 5 different exercises that I should perform several times a day.  I vow to comply (hopefully, more faithfully than I did the exercises recommended by the naturopath).

            Over the next 4 days, my family and I take a long relaxing weekend at a condo on the shore of Lake Erie.  I take it easy, avoid heavy lifting, and do the recommended exercises.  I seem to be improving incrementally, but not dramatically.  On return, I have one more visit with Dr. D, the chiropractor.  This last visit is the most business-like of any of the visits so far.  After a short wait, Dr. D. comes in and does a quick exam.  He spends about 10 minutes with me.  He does some non-aggressive adjustments.  This time, he does not vigorously crack my neck.  When he steps out of the room, I snoop around and I come across a poster for applied kinesiology.  Included on the poster are what appear to be pressure points on the body which correspond with various body organs.  Also, there is a list of therapeutic extracts which include the previously mentioned spleen, thyroid extracts, liver, lung, etc.  Here is a whole field of medicine practiced by Dr. D which he appears not to have brought into play.  I wonder why.  Perhaps his knowledge that I am a physician has caused him to stay in the mainstream, or maybe this is an area explored more commonly by his associates (or maybe these extracts are aerosolized and pumped into the ventilation systems of the exam rooms!).  I feel like my experimentation with chiropractic care is coming to an end.  I have seen the doctor for treatment of both my chronic lower back pain, and also during an acute flare up.

[Next week, I review the results and conclusions drawn from my visits to the Chiropractor.]

Visit to the Chiropracter: Acute back pain.

     For the next few days after my initial visit to the chiropractor, my neck remains sore.  My lower back pain is little changed despite the addition of daily stretching.  As my second visit looms, I experience trepidation regarding the upcoming adjustment of my neck.  I again contemplate canceling.  At the second visit, I am taken directly to the exam room.  Dr. D places the x-rays taken at the prior visit on the light box for viewing. He points out that my left pelvis is higher than my right.  He suggests that I might eventually require a heel raise, but for now, he wants to see how I respond to spinal adjustments.  He again instructs his assistant to “loosen me up.”  She keys in on the same tender spot along the mid-lower left side of my back.  Fortunately, this time she is less aggressive in her torture.  Dr. D returns and performs a series of adjustments similar to the first visit.  I tolerate the cracking of my neck a bit better despite experiencing the same creeping feeling as he lurks around the room with me face down on the table.  I again am sent to the decompression machine which is set this time for 12 minutes with 55 lbs. of tension.  He says he would like me back in one week.  I state my agreement, but in reality, I want to see how much of a bill I have been racking up before scheduling my return.

            My insurance covers chiropractic care at a second-tier level, unlike primary care visits to my regular doctor for which I only have to pay a small co-pay.  For the chiropractor, I have a co-pay, and I must cover my ~$1000 deductible before the insurance kicks in.  When I finally get the bill 2 weeks later, I owe a total of $252.39 for the two visits.  My insurance company has negotiated the price down from an original $510 total - kind of pricey, but not too bad.

            As the weeks pass, I am unable to appreciate any improvement in my chronic lower back stiffness.  I am underwhelmed.  I finally schedule a return visit a few months later, but little changes.  My friends tell me not to lose faith.  My brother-in-law relates his personal experience with shoulder pain which miraculously resolved with a single adjustment.  A commenter on my blog says he achieves the most benefit from the chiropractor when he is seen for acute disabling back pain rather than for non-urgent adjustments.  He relates an instance when a single adjustment helped him go from severe pain to rock climbing within a week’s time.  I am left to wonder.  Coincidentally, I do not have to wait long to put the acute back pain theory to the test.  In a particularly vigorous day, as I attempt to reclaim my youth, I play pick-up basketball in the park followed by ice hockey with my two older sons (indoor rink).  By the evening, I can feel my back stiffening up.  By the next morning, I am in a crisis.  My back pain is markedly worse and I find myself walking stooped over.  I feel myself aging rapidly!  At this rate, I will be an old man before the end of the week.  I find myself lying on the floor of my office between patients.  Now is the time to get back to the chiropractor.  Despite my skepticism, I must admit I am eager for some immediate relief.  I give Dr. D’s office a call, and I am happy to find out that I can be seen in just a couple of days.  By the time the appointment rolls around, I am in need of a savior.

            At my visit, I tell Dr. D about my worsened condition.  He gives me a nod of understanding, observes my desperate attempt to touch my toes, and then he steps out while the assistant tries to relax my tightened back with massage and some warm blankets. When Dr. D returns, he is all business.  He has me lie face down on the exam table.  He presses on the back of my pelvis bone and asks me to lift my left leg towards the sky while he pushes down.  He does a few adjustments and then again tests my leg strength.  After a few rounds of this, it appears that I am able to offer more resistance. Am I actually stronger?  Am I just trying harder?  He explains that in response to the strain of bending over while playing hockey my “glutes had given out.”  He seems quite confident that the adjustments performed should make a difference.  I choose this time to ask him for some exercises I might perform to assist with my recovery.  I would like to play a more active role in my recovery.  He blows off this question, but prescribes a visit to the physical therapist located in his office.

            I am walking more upright immediately after my visit, but as the day progresses I deteriorate to my pre-visit condition.  I hold out hope for my upcoming visit to the physical therapist and a few more adjustments with Dr. D.

Visit to the Chiropractor : Cracking my back.

As I wait for the chiropractor, I examine the walls for interesting tidbits.  The room is unremarkable except for a large exam table with many detachable parts and a complicated system of foot pedals.  On the wall directly opposite the door is a foam board with multiple cubbies containing roughly a hundred glass vials.  Arranged in alphabetical order are various pills and powders.  Most of the names are foreign to me.  I recognize one labeled “thymus” and another “spleen”.  Apparently, these are some of the herbs and homeopathic remedies that are advertised in the center’s brochure.  On the long wall to the right of the door is a bulletin board with various postings.  One is a picture which shows MRI images of a person’s lower spine.  The images are labeled “before” and “after” decompression.  The “before” shot shows a vertebral disc impinging on the spinal cord while the “after” shot looks entirely normal.  I also see an advertisement for “estronex”, a urine test that measures estrogen metabolites to determine a woman’s risk for breast cancer.  This is a bold claim, one which I sincerely doubt.  I will have to research its veracity later.

            After a short while, Dr. D enters the room.  He observes me standing, stepping forward, and perched on one leg.  He remarks that my pelvis is tilted.  One side rides higher than the other.  He then instructs me to lay face down on the exam table, and he calls for the assistant.  He instructs her to “loosen me up”.  She spends about 10 minutes attempting to relax the muscles which run along my spine.  Believe me, this is not an easy task.  She presses with her palms, her forearms, and even her elbows.  The sensation alternates between soothing and excruciating depending on where and how firmly she applies pressure.  On completion, she places some warm towels on my back and calls the doctor.  He has me remain lying face down.  He places a few lifts under my hips and then begins to do some “adjustments”.  He asks me to breathe in, presses over my mid-spine, and cracks my back.  Next, he sits at the foot of the table and pulls my legs.  Then, he begins to circle.  His circling reminds me of a vulture sizing up his prey.  I remember my friend John’s comments, and I reflexively tense up despite my best efforts to remain relaxed!  He moves in for the kill.  He presses on my head and the side of my neck and sends a ripple of cracking up my neck.  He then repeats this from the other side (not my favorite feeling).  I cautiously wiggle my hands and feet.  I am relieved to find that I am not paralyzed.  Next, he pushes down on various portions of my spine and when he does, the table collapses and makes a loud clunking sound.  He does a few further adjustments while I lie on my side and to my legs.  He is done after about 15 minutes.  It seems like a decent amount of hands-on care and face time with the doctor.

            Doctor D then recommends that we do an x-ray which we will review at the next visit.  He also prescribes a session on the decompression machine.  He inquires whether I drink soda.  When I answer in the affirmative, he gives a knowing nod of his head as if he has found the cause of all my ills.  He recommends I cut out soda, but aside from this, he doesn’t stress any other dietary restrictions.  I am struck that he does not suggest any particular exercises or lifestyle changes.  He doesn’t even make a plug for the seat rests that are littered throughout his office. 

            I am next taken to a separate room and an upright x-ray of my spine is taken.  The x-ray machine appears ancient, and the staff seems somewhat blasé about the risk of radiation exposure.  The assistant then takes me to the decompression machine which I am eager to experience after seeing the aforementioned “before” and “after” pictures.  I imagine a medieval torture device, but in fact, the machine appears benign.  I lie face down on a padded table, and a soft Velcro belt is placed around my waist.  The belt is attached to an ancient appearing machine which basically provides traction on one’s spine.  The theory is that it opens the spaces between your vertebrae.  I spend the next 10 minutes lying in a quiet room as the machine applies moderate traction to my spine. It actually feels pretty good.  After awhile, I am unhooked and led to the check out counter. I arrange a follow up visit for the following Monday.

            As I exit the building, I reflect on my visit.  Similarly to my visit with the Naturopath, I am impressed by the amount of time that was spent with me by both the doctor and his staff.  I appreciate all the hands-on time with the exception of the neck cracking.  I can see why people would prefer to see a chiropractor over an internist for their back pain.  Here, it at least seems that something is being done to get you better rather than just covering up the discomfort with pain killers.  I am surprised that I wasn’t given instruction regarding things to avoid and exercises to perform.  With the chiropractor, as opposed to the Naturopath, I seem to play little role in getting my back to feel better.  Last, my neck is sore!  Perhaps this will distract me from my lower back discomfort.

[Next week: Visit to the Chiropractor-part III]

My visit to the Chiropractor

My lower back pain, which has not abated despite the Naturopathic interventions, has led me to next see a chiropractor.  I have always viewed chiropractors through wary eyes, mainly because I value my spinal cord and the thought of someone manipulating my vertebrae (which protectively encircle the spinal cord) scares me!  As I mentioned previously, I willingly refer patients with lower back pain to chiropractors provided the patient requests it and the referral helps them get insurance reimbursement.  I am skeptical whether the patient will truly benefit.  According to my reference bible on alternative medicine, chiropractic care is the second largest primary health care field in the world.  The goal of the chiropractor is to correct vertebral subluxation. While it seems logical that correcting subluxations (a medical term for a dislocated joint - in this case, between two vertebra) should improves one’s back pain, the field of chiropractics also claims that manipulating the spine and treating vertebral subluxation can  provide additional benefits such as curing various diseases and non-orthopedic maladies.  In fact, the father of chiropractic care, Daniel Palmer, purportedly cured a man of chronic deafness following a spinal adjustment.  Also, don’t forget about the patient whom I saw in Wilkesboro diagnosed with “hepatitis” by her chiropractor.

 Prior to my visit, Beth and I went out to dinner with a couple of our friends, and I casually mentioned that I had an upcoming chiropractic visit.  My friend, John, became very animated and related that he has repeatedly visited a chiropractor ever since he was in high school.  He said every so often his back “goes out of whack” and he goes to see a chiropractor for a few adjustments and before long, his back returns to normal.  He gave me one warning though, “Be aware of the chiropractor when he moves in to adjust your neck.”  He described lying flat on an exam table with his face down.  Out of the corner of his eye, he can see the doctor circling around the room while telling him to relax.  When John appears unawares, he will do an aggressive adjustment of his neck.  Of course, this just heightens the already growing reservations which I have about my upcoming visit. By the morning of my visit my back is actually feeling a bit better and I contemplate canceling, but in the end I buck up and go.

            The office is in a non-descript single level office complex.  It is small and a bit dated compared to most doctors’ offices.  I fill out the requisite history form.  I notice back rests still wrapped in cellophane placed around the lobby in several chairs and in a large basket in the corner.  A price of $25 is clearly labeled on each cushion.  Perhaps this is a source of additional revenue.  After waiting for about 15 minutes, the receptionist gives me a cup and points me toward a small rest room with the request that I provide a urine sample.  I suppose this is to exclude a urinary tract infection as the cause of my back pain.  I am quite sure that I don’t have a urinary tract infection.  I contemplate professing that I am an infectious disease doctor and based on my lack of urinary frequency, burning, or other systemic signs, I clearly don’t have an infection.  In the end, I decide it is best to just go along.  After proudly providing an assistant with a frothy cup of warm urine, I am led to a seat in a small check-in room.  While I spend the next 5 minutes waiting, I start to read the flyers on the walls.  I am struck by a flyer that says, “Do Not Get a Flu Shot!”  It then gives a litany of reasons that flu shots should be avoided while citing various medical journals and specialists to support these claims.  A few of the justifications include: “It does not prevent pneumonia in older persons (Lancet, New England Journal of Medicine); 5 consecutive flu shots increase the risk of developing Alzheimer’s 10X.;  Studies suggest low vitamin D levels may actually be responsible for flu symptoms rather than the influenza virus!”  Needless to say, I am flabbergasted.  Two visits to alternative practioners and two attacks on vaccination! Later, I did some research on the claim about Alzheimer’s risk and found out that the doctor who made this claim had been stripped of his medical license by the South Carolina Medical Board for quackery.

            I am interrupted by the chiropractor’s assistant.  She reviews my history form and confirms my complaints.  I am then led into the examining/adjustment room. The assistant instructs me to get undressed and says she has some shorts for me to wear if I desire.  I say, “No, I am comfortable in my underwear.”  After an awkward silence, she says, “Okay, why don’t you just leave your pants on and strip off your shirt.”  Apparently, standing in my underwear is not appropriate.  She steps out and I am forced to contemplate my choice of dress or undress while I wait for the doctor to come in.

[Next week, Cracking my back.]

Visit to the Naturopath: my conclusions.

     How am I doing?  Are the diet and supplements doing their job?  If you remember, I went to the naturopath with concerns about insomnia, frequent headaches, and various musculoskeletal complaints. Two weeks after starting the new regimen, I began a busy rotation in the hospital!  As if on schedule, my insomnia struck.  I faithfully took the prescribed remedies, but my inability to sleep was worse than ever.  No sleep, combined with no coffee in the morning, is a brutal combination. I managed to survive a busy first day without too much problem. On night number two, I went to bed tired but nervous.  I wondered, “What if I can’t sleep again?”  As I lay down in bed, my heart started to race. I knew this was a bad sign. I strove to stay “natural”. I wanted to give the naturopathy a chance. I checked the clock every 15 minutes and right around midnight, I realized that I was no closer to sleep, but much closer to another sleep-deprived night. Just the thought of another sleepless night followed by a busy day at work made my heart beat faster.  Finally, I broke down and took an ambien (a sleeping pill). This bought me 3 ½ hours of sleep.  Not enough for someone who needs 8 hours a night, but enough to allow me to survive day #2 at work.  I repeated this pattern the following two nights, attempting natural sleep followed by a brief ambien-induced coma.  I was a train wreck.  I was forced to drink coffee in the morning just to survive.

On the fifth night, I decided it was time to try something different.  I forced myself to go for a run before dinner (more of a stumble in my sleep-deprived state); I stayed up 1 hour later than usual; I read my book; and, I convinced my wife to “have relations” with me (code words for sex).  I managed to sleep about 5 hours without the help of ambien!  Finally, the cycle seems to be breaking.

On the sixth night, I played basketball in the evening.  I was so tired, I found myself fouling people uncontrollably.  No one was mistaking me for Michael Jordan.  That night, I repeated my new routine of  staying up late, reading (it was getting hard to focus), and “having relations” with Beth.  She really is very tolerant of me.  My routine was rewarded with 9 hours of blissful sleep. The following nights, I slept well even without my wife’s assistance (I can only push her so far).  I had finally shed the yoke of insomnia!  It did not appear that my Lycopodium, Nux Vomica, or Calcarea Carbonica, all of which claim to treat insomnia, helped in any way. Maybe not enough time had passed.  Maybe I am not a true believer.

            What about my other complaints?  I must admit I have had a pretty good stretch regarding my headaches.  During my week of insomnia, I had some minor headaches, but I never had to resort to taking my prescribed Maxalt.  Since I began sleeping again, I have had no major headaches.  My head might still get a little achy, but nothing disabling.  Could this be a sign that the Tuberculinum, Nux Vomica, and the Calcarea Carbonica are doing their intended job?  Who knows?  I suspect cutting back my coffee intake and the near elimination of alcohol are largely the reason, but who knows.  Maybe it is my more relaxed outlook, thanks to the Linden Flower extract.  

            My back, hip, and foot pains are unchanged.  I suppose had I more rigorously adhered to the exercise and stretching program this might not be the case, but the anti-inflammatory diet clearly hasn’t done the trick.  Nor have the multiple anti-inflammatory and “adrenal adaptogen” substances that I have been taking.  I have continued with my regular exercise routine which includes biking to work (9 miles each way) 1-2 times/week, basketball 1-2 times/week, maybe a trip or two to the gym for some weight lifting and stretching, and then chasing my kids around. After any of these activities, lifting and stretching aside, I feel pretty inflamed the next day!

            In conclusion, I grade my Naturopathic experience a 5 on a 1 to 10 scale, with 10 being the best score possible.  I am very impressed with the amount of time that the naturopathic doctor spent with me.  This amount of time would be unheard of in a traditional medical practice.  I think that the lifestyle modifications, both dietary and exercise, prescribed by the naturopath are fairly common sense and similar to that which a standard nutritionist and physical therapist might recommend.  Some aspects of the “anti-inflammatory” diet are obvious, such as eating natural foods, more fruits and vegetables and avoiding processed foods and saturated fats.  Again, these are not groundbreaking principles.  I am less sure about the restrictions on coffee and alcohol.  The unique components of the naturopathic experience are the supplements and the homeopathic remedies.  I can see the allure of these relatively inexpensive remedies. You can look up your symptoms in a reference book and then find any number of “natural” supplements and homeopathic remedies.  This ability to determine your own treatment plan, with the naturopath’s assistance, is very empowering.  Unfortunately, beyond these admirable qualities, these remedies largely fall flat.  If I am going to spend $150- 200 a month on remedies, I would like to see some proof that they work, not just writing in a century old book!  I would like to think that medical science has advanced the practice of medicine even just a little bit since Boericke wrote his homeopathic treatise, Materia Medica, in 1929!  Just because it is written in a book does not make it true.  Despite the many fallibilities of modern medicine, I believe there is a role for proof of principle.  I will admit that my 6 weeks experimentation with Naturopathic medicine was just that - “experimentation” - but I certainly have my doubts which have been magnified the more I have learned.  I liked the holistic approach to medicine, but I think my money would be better spent seeing a nutritionist and a physical therapist (and my insurance might even help).

Visit to the Naturopath: Homeopathy.

Now we come to a class of remedies which in my mind are truly “alternative”. Homeopathy has always intrigued and perplexed me. First, there is the “law of similars” whereby a remedy is selected to provoke the very symptoms one is trying to treat.  This sounds a little bit like desensitizing someone to an allergy.  One might imagine its working in a manner similar to a vaccine which primes the immune system to develop a response to similar stimuli.  Thus, it assists your natural immunity in responding to an inciting agent and decreases subsequent “inflammation”.  So far so good…. 

Now the second premise of homeopathy is that increasingly dilute doses are increasingly potent. This is hard for me to stomach, and it throws a big wrench into my immune stimulation hypothesis.  Despite my skepticism, I understand that in Europe homeopathy is far more recognized as a mainstream medical therapy than within the United States. With these previously mentioned underlying premises in mind, here are the homeopathic remedies I have been prescribed, and a bit of my research regarding their intended uses:

1)     Lycopdium- It is derived from an evergreen plant in Europe and North America. It has been used since the Middle Ages for a broad spectrum of ailments ranging from gout to digestive disorders. It can be used for chronic insecurity, fear of an upcoming event, sleeplessness, nightmares, headaches, and more. (I don’t appreciate any overwhelming insecurities, but I definitely fear my upcoming bouts of insomnia and headaches!)

2)     Tuberculinum- I found an incredibly long list of indications for this one. This medicine is intended for those with a family history of tuberculosis, for those prone to colds, allergies or other respiratory disorders. To me, this is the oddest of the prescribed medications especially since I oversee the county tuberculosis program. I'm having a hard time determining why this one was prescribed. The Internet provides an extremely long list of potential afflictions or traits that are benefited by taking this medication including the treatment of “incipient tuberculosis”. As I peruse this long list of potential maladies cured by tuberculinum, the only one I see that pertains to me is “deep brain headaches”.

3)     Nux Vomica - Now this one even sounds disgusting! According to Boericke’s Materia Medica (originally published in 1927) but still used today, "Nux is preeminently the remedy for many of the conditions incident to modern life. The typical Nux Vomica patient is rather thin, spare, quick, active, nervous, and irritable. He does a good deal of mental work; has mental strains and leads a sedentary life, found in prolonged office work, over study, and close application to business, with its cares and anxieties." There are then about 20 pages of symptoms for which it might be useful including lumbar back pain, insomnia, and headaches. Of all the medications so far, this is the one for me!

4)     Calcarea Carbonica - According to Boericke, its "chief action is centered on the vegetative sphere, impaired nutrition being the keynote of its action, the glands, skin and bone, being instrumental in the changes wrought. Again, it is good for incipient phthsis” (an archaic name for tuberculosis)! As I read over these remedies and the cookbook-like fashion in which they can be prescribed, I can't get over the feeling that this is similar to how medicine was practiced many, many years ago, during a time when people generally died at the age of 40! Among the 19 pages of symptoms that might be cured with Calcarea Carbonica, I find insomnia, back pain, and headaches.  I'm feeling better already!

As I read over the descriptions of the many possible uses of these homeopathic remedies, I hearken back to the time when medicine was practiced much differently. For direct comparison I decide to pull out a few of my ancient medical texts. One such text, The Principles and Practice of Medicine, by William Osler MD, published in 1899, preaches that the best way to treat tuberculosis is to “make a patient grow fat” and place them in the open air.  Diabetes can be treated with “opium”, or alternatively with “valerian root”. It seems that traditional medicine has come a long way, but homeopathy remains unchanged.

[Next week…The results of my Naturopathic adventure.]

Visit to the Naturopath: Prescribed Remedies.

            As part of my therapeutic regimen, my naturopath prescribed 7 supplements and 4 homeopathic remedies.  I must admit that these last 4 pique my interest the most.  The goal of the medications, to the best of my understanding, is to decrease the inflammation in my body and regulate my adrenal glands, and in doing so, cure me of headaches and insomnia.  Although I am inherently skeptical, I am eager to give them a try.  After I get home, I lay out all the pills for my wife to admire.  As I calculate the total number of remedies (10 pills, 10 drops, 2 scoops, 7 pellets, and 2 teaspoons) that I am supposed to take each day, I am overwhelmed.  I wonder if there will be any room left in my stomach for food!  Here is a run down of the prescriptions and my understanding of their purposes:

1)     Aller-C- A dietary supplement of quercetin, vitamin C, and bioflavinoids. According to the manufacturer, it is a “potent combination formula used to moderate the inflammatory response.  Quercetin promotes decreased production of histamine and the 60 citrus bioflavinoid complex supports the strength of capillaries.” Interestingly, I have never heard of quercetin before, but when I google it, I am able to find circumstantial evidence for the manufacturer’s claims and I am strangely reassured.

2)     B-complex vitamin- Not much to say hear.  Even in the small village of Pramkese, Ghana, the villagers felt B-complex vitamins were imbued with magical healing powers.

3)     Omega- 3 Fish Oil capsules- Again, hard to argue with this one.  Even Wikipedia states that they “are known to reduce inflammation throughout the body.”

4)     Vitamin C, Calcium citrate, and Magnesium citrate powder- Even after I read the product insert, I am not sure why I will be taking this one.  It appears to primarily be for bone health.  It comes in a powder which when mixed with water fizzes and tastes like alka-seltzer.

5)     Seriphos (phosphorylated serine)- The bottle states it is an “adaptogen and adrenal support” agent.  These are foreign terms to me.  The manufacturer’s website expands on the benefits of phosphorylated serine.  It is purported to enhance memory and to impact circadian cortisol rhythms.  The website excerpts a few random and very small studies as evidence for these claims.  Mainly it is selectively quoting the researchers who did the studies as justification for their claims.  Not very hard scientific evidence, but intriguing!

6)     Linden Flower extract- All I can find about this one is that it “promotes relaxation”.  Sounds good to me.  Apparently this will have to replace my evening beer that was cut out in the “anti-inflammatory” diet!

7)     Fruit anthocyanins- A pure concentrated syrup of grapes, blueberries, pomegranate, aroniaberry, elderberry, and raspberry.  What are aroniaberries?!? The website associates anthocyanins with many possible benefits including anti-viral, anti-bacterial, anti-cancer, and basically anti-everything bad properties!

These supplements cost a cool $150 for one month’s supply.  I realize I have now indistinguishable from several of my patients, and even some of my wife’s neurotic friends, who are frantically popping pills, going on periodic fasts, and getting “high colonics” in hopes of achieving natural health!  Well, there is no turning back now.

[Next week… The Homeopathic remedies]