Visit to the Naturopath: the "anti-inflammatory" diet

            Soon after my visit to the Naturopath, I realized that among the many things proscribed, the biggest challenge would be adhering to the diet, or more specifically the “anti-inflammatory diet”.  I understand that there are many vocal proponents of this and similar diets, both among naturopaths and the general public.  In fact, as I drove to work a few days after my appointment, I tuned into a short segment concerning these diets on National Public Radio.  The principle of the anti-inflammatory diet is that there is a direct link between the foods that we eat and the amount of inflammation in our bodies. Certain foods, such as organic fruits and vegetables, are considered anti-inflammatory whereas other foods, such as those heavily processed or high in saturated fats, are considered pro-inflammatory.  According to the interviewee on NPR, the support for these diets originates in studies which assessed life expectancy and health outcomes in large populations and then attempted to link these outcomes to their diets.  The interviewee’s conclusion was that although the findings are intriguing, there is no conclusive evidence of benefit.

            The guidelines for my “anti-inflammatory diet” are to eat more essential fatty acids (found in raw seeds and cold-pressed oils), bioflavonoids (found in organic vegetables and fruits), and foods high in vitamin C, E, B3, B6, Biotin, Copper, Magnesium, Selenium and Zinc.  Foods to avoid include red meat (except grass-fed beef), processed oils, dairy, commercially processed eggs, pre-packaged foods, alcohol, coffee, and peanuts!  As I read the list, I began to cringe. This was not going to be easy.  I live on dairy, alcohol, coffee, and peanuts!  Give up my morning java and my evening beer?!?  What is the point of living if I can’t enjoy life?  Hadn’t I recently read that coffee is the number one source of anti-oxidants in the American diet? Isn’t a beer a day good for you? As I read the diet out loud to Beth, I could see her start to smirk.  I could tell she was going to enjoy watching me suffer!  We both decided the first step would be to go to the local organic food store, or “Whole Paycheck”, as I like to call the establishment of similar name.

            I truly despise this store.  No doubt the fruits and veggies look great, but boy are they pricey!  Needless to say, there are not many persons using food stamps here.  Again, I am struck that visits to the naturopath and “anti-inflammatory” diets seem more geared towards the well-to-do.  Well, I digress.  As I entered Whole Paycheck (or similarly named establishment), I immediately encountered rows and stacks of immaculate fruits and vegetables.  Being a strawberry lover, I was drawn to the beautiful mounds of strawberries.  I noticed one stack of organic strawberries and an identical mound next to it of regular strawberries.  They looked exactly the same to me.  In fact, they were produced by the same company; the only noticeable difference was a small emblem saying “organic” on one set of packages.  The berries were all red, juicy, and delectable appearing.  I then noticed the price difference.  The organic strawberries were $4.69 per package and the non-organic $2.69.  You must be kidding me!  I begrudgingly grabbed a package of the more expensive organic berries.  I picked out some “organic veggies” (I am not a big veggie eater), some organic eggs, grass-fed hamburger meat, and some soy milk.  My spirits hit a low point as I paid $50 at check-out for a measly single sack of groceries.

            As I arrived home and looked over my upcoming diet, I decided to indulge in one last night of decadence… beer, cheese, a poorly treated cow, and maybe even some pre-packaged food.  I told myself, “Tomorrow, I begin the austerity... I mean ‘anti-inflammatory diet’.”

[Next week…examining the pills prescribed by my Naturopath]

Visit to the Naturopath: The treatment plan.

            After one-and-a-half hours of taking a very complete history, my naturopath doctor determined that I was suffering from general “inflammation”. This combined with a malfunctioning adrenal gland accounted for my struggles with headaches, insomnia, back pain, and plantar fasciitis. She was now ready to outline a therapeutic plan for my recovery.  First, she suggested some exercises I should do for my back and feet. She placed two tennis balls in a sock and demonstrated how to use these to massage my lower back and neck using the floor or a wall as resistance. She suggested some stretching exercises for my feet and recommended I pick up marbles with my toes to strengthen my foot muscles.  Also, I was to hang upside down from my hip crease to create a gap between my vertebrae and to focus on building my “core” muscles. These all seemed like reasonable suggestions, much like one might hear from a physical therapist.

            Only when she started to devise a regimen of dietary supplements and homeopathic medications did she really surprise me. She seemed vexed while trying to find the appropriate remedy for my headaches. She pored over one of her books on homeopathic remedies, struggling to find the correct treatment. It appeared that my headache did not fit into any of the well-categorized groups outlined in her text. She probed deeper, asking me about the location of my headaches:  “Are they more on the right or the left side? What triggers your headaches? What time of day do your headaches occur?”  Finally, she paused and looked up from the book laid out in front of her and said, “You might think this next question is a bit odd.”  I must admit she did not disappoint.  She asked, “Are you afraid of snakes?”  Had I misheard her?  No, she actually had asked if I was afraid of snakes!  The implication was that this might have some bearing on the as yet to be chosen headache remedy!  “No,” I stated.  “I actually am quite fascinated by snakes.  In fact, we own a ball python named Monty.”  Disappointed, she again immersed herself in her text.  After flipping through a few more pages, she inquired if being hungry precipitated my headaches.  Happily, I said, “Why yes, I often get a headache when I am hungry or I miss a meal.  In fact, I am often able to stave off a smoldering headache by getting something to eat.”  She seemed pleased with this information, and added two new homeopathic medicines to the regimen, Nux Vomica and Tuberculinum.  Not the prettiest sounding medications, but I held my tongue.

            The doctor printed out my personalized treatment plan.  The focus was on an “anti-inflammatory diet”, several exercises, dietary supplements, and 4 homeopathic medications.  She explained that homeopathy was founded on the “law of similars”. Basically, the goal is to administer a substance which provokes the very symptom you are trying to cure, but at very miniscule doses.  In fact, she explained, “the more dilute the dose, the more powerful the effect.”  As she expounded on this bedrock principle of homeopathy, I thought to myself how very counter-intuitive it seemed.  Already, I could tell that I would be losing the “placebo effect” due to my inherent skepticism.

            With two pages of printed out treatment plan in hand, the doctor personally checked me out and gave me the listed remedies.  It was 6 p.m., two hours after I had arrived.  In hand, I had eleven prescribed remedies that would cure my “inflammation” and control my adrenal gland.  I left strangely satisfied.  Despite being 400 dollars poorer, I had received two hours of a doctor’s personalized attention, and I had a dizzying array of new therapies to try out!

[Next week…. The “anti-inflammatory” diet]

A visit to the Naturopath

     Naturopathy is focused on the stimulation of a person’s “vital force” or one’s own healing capacity. It comprises a holistic approach to facilitate the body’s natural mechanisms to be well.  There is a focus on diet, exercise, and lifestyle changes aided by the use of dietary supplements and homeopathic remedies. I could understand the appeal of this ostensibly reasonable approach.  I originally had set my sights on seeing a  practioner of homeopathy, but I was unable to find anyone for whom this was the sole focus of their practice. It was mostly MD’s providing homeopathic remedies on the side to supplement their income. The naturopath I found had been recommended by a close friend, and her website appeared very professional. I decided I should go with a credible practioner even if it meant paying a bit more.

            The clinic was located in a nondescript office on the second floor of a historic building. There was no signage outside to indicate its presence. This was clearly a word-of-mouth establishment. The waiting room was small, and the smell of incense wafted through the air. On one wall were shelves displaying a vast array of available supplements and remedies, much like the stand of hair care products that confronts you as you exit a beauty parlor.  There was an inviting photo of an empty dock on a mountain lake. On the side wall was a stand with various teas for consumption and purchase. While able to appreciate the calming feel of the place, I could also glimpse its money making potential.

            After a wait of only a few minutes, I was ushered by the doctor into her spacious office/exam room.  I sat down on a love seat opposite her large wooden desk. On the far side of the room was a typical exam table.  The walls were covered with shelves full of books of the trade.  I recognized a few internal medicine and obstetric texts that were over 20 years old and appeared to be gathering dust. In contrast, closer to her desk were several folders and homeopathic reference books that appeared well worn from frequent use.  The doctor sat down behind her desk and flipped open her laptop.  Over the next hour and a half, we reviewed the extensive questionnaire that I had been asked to complete prior to my visit.  It covered my past medical history, current medical complaints, and lifestyle.  She used this questionnaire as a jumping off point for more detailed questions about each of my complaints. Throughout my entire visit, she diligently tapped away on the keyboard and periodically referred to the folders and reference books at her disposal. 

            On the whole, the visit reminded me of a typical visit to a general medical doctor. The exception being the length of time she spent with me and the depth of the questions with which she probed my history.  With regard to my headaches, she tried to define their frequency, location, triggering and exacerbating factors, remedies I had tried in the past, and the impact of my diet or sleep.  She asked similar in-depth questions regarding all of my complaints.  She showed particular interest in my bowel regimen, the consistency and frequency of my stools, and also whether I had any skin problems. She even delved into possible sources of angst stemming from my childhood! We discussed my insomnia, lower back pain, my chronic foot pains from plantar fasciitis, and my Type A personality. I must say I was impressed. She was thorough and yet she remained relaxed, in no rush at all.

            After getting more and more specific with her questions, she finally leaned back in her chair and contemplated for a short while and then she said, “I think I know what is going on”. I waited for the answer with baited breath. After an extended pause, she said, “you have inflammation”. The unifying diagnosis just hung in the air for a few seconds as we contemplated its significance. I must admit I had to stifle a guffaw. Over one hour of probing questions, no stone had been left unturned, and this was the answer: “inflammation”. I must admit my incredulity was heightened by the fact that in my profession as an infectious diseases doctor, inflammation is a symptom rather than a diagnosis in its own right.  I have no doubt I could declare this diagnosis in all of my patients and be correct 99% of the time! She was not done. The next part of my diagnosis was even more intriguing. She concluded that my adrenal gland was out of whack! Apparently, my cortisol (a hormone produced by the adrenal glands) levels were not following the appropriate diurnal rhythms, hence my insomnia. She inquired if I would like to have my cortisol levels checked via a saliva test. I balked at the $151 dollar cost, and we agreed to proceed with empiric management and consider the test at a later date. Now that we had a diagnosis, she went to work developing a therapeutic regimen.

[next week, the treatment plan]

The starting point (VII of VII): Who am I, and why do I keep having children?

    My fourth major concern is my memory, or lack there of. I ruled out a career in politics early on when I realized I am abysmal at remembering names, although I must admit that thought of Sarah Palin running for President has made me reconsider. For the life of me, I can’t recall the plot line of most movies I have seen. Beth reassures me this is normal, but she has been bringing up that we should obtain long-term health care insurance with increasing frequency! All of this would be a bit more humorous were it not that my mother currently resides in an Alzheimer’s care facility in Tampa, Florida where she has been since the ripe old age of 67! I have cycled through daily ibuprofen, daily aspirin, vitamin E, and ginko, but invariably after taking anything for a while I run across new research that debunks the benefits and points out possible detrimental effects. Beth encourages me to do mind games to stay sharp, but I suck at crossword puzzles, get bored with sudoku, and fall asleep when doing brain teasers. To make matters worse, when I did have that head CT for my headaches, the resident who initially reviewed the CT noted some “mild” atrophy. Fortunately, the final report did not confirm this, but I admit I am too scared to look into this further! I, of course, have assumed the worst. I figure I have another 15-20 years before senility sets in.

            Do I have any other medical concerns? I am ashamed to admit there are more. My right shoulder appears to have some form of rotator cuff tendonitis that leads to soreness after activities such as basketball or throwing a ball. I periodically get pain in my left groin region after sporting activities. I have diagnosed myself with a lower abdominal muscle strain, but its failure to fully improve after prolonged periods of inactivity has led me to a sneaking suspicion that it may instead be a hernia (basically my intestines protruding through a weakness in my lower abdominal wall). I repeatedly give myself a half-hearted physical exam to search for the tell-tale bulge of a hernia that is more obvious when coughing or bearing down. I can’t clearly identify any such bulge, but as an internist, I remember missing a few small hernias in my patients that the surgeon was able to pick up. A hernia!?! A true sign of old age!

            Last, although not really a malady, I am overly fertile. My wife is reeling from the effects of 3 young boys, ages 10, 8, and 3. She is too stressed to reliably remember to take “the pill” and therefore she often refuses to be in a closed room at night with me for fear of becoming pregnant again. She has of course requested that I get “fixed”. I, of course, do not feel that I am broken; therefore, I have done my best to delay this inevitable procedure. Why you may ask… I do not desire any more children, but I do have a reluctance to entrust “my boys” (and I don’t mean Connor, David, or Thayer) to a surgeon. My friends reassure me that having the big “V” is really no big deal, but I know otherwise. I have the memory of one patient whom I cared for in North Wilkesboro who had developed an infection at his vasectomy site. The result was that he was hospitalized, and his scrotum was left open for daily dressing changes by the young nurses while he received IV antibiotics. One exposure like this is enough to force any man to think twice before having a vasectomy. I suggested to Beth that we try herbal remedies to cure my sexual potency, but when I last checked, the door to our bedroom was still locked.

            Now that I have chronicled my maladies in excruciating detail… here is my plan. First, I will make an appointment with an internal medicine doctor for a full check-up. We will see how the “modern” medical experience goes. Thereafter, I will begin my exploration of the “dark side”. I plan on systematically trying different “alternative” medical modalities for my various complaints. My sister, Amy, has brought up the point that if something works too well then my exodus will come to a quick end, and I won’t have any material for my planned book. This is a risk I am willing to take. I figure if the experiment goes too well and all my ailments are cured then sacrificing writing a book is a small price to pay! I am fairly confident that it will take a while to solve all my problems, and if they do resolve, I need only to play a few games of basketball to discover some new problems. This is where the journey begins.

[stayed tuned…next week, a visit to the Naturopath]

The starting point (VI of VII): What "ails" me

      Like many middle-agers, my list of complaints is long. Life often goes too fast for one to address the multiple nagging aches that seem to cling to you over the years. I have suffered from frequent headaches since I was a child. I remember the headaches starting when I was in middle school playing pee-wee football. The headaches become more frequent and severe during my residency. I was fortunate to rotate through a headache clinic as part of my internal medicine training. Here, I diagnosed myself with a combination of tension and non-classical migraine headaches. As doctors are prone to do, I began treating myself... unsuccessfully. I had little relief with over-the-counter medications such as Tylenol, ibuprofen, and naprosyn. I had a friend prescribe me an antidepressant called amitriptyline for headache prevention. It didn’t seem to have any impact on my headaches, but I did sleep well while taking it and I had a very dry mouth. Taking a mere 25 mg dose, about ¼ the normal dose I have often prescribed to little old ladies, I was dead to the world. Normally a light sleeper, I could now sleep through a fire alarm and when I did awaken I felt groggy until noon, which is not a good state for a busy 3^rd year medical resident to be in! I sought guidance from an ophthalmologist, but my eyes were normal. I tried allergy meds, thinking maybe I had sinus allergies, all to no avail. 

      Fortunately, the frequency of my headaches usually wanes after a month or so of increased frequency and I would forget about them being an issue.     This changed a few years back when I was nearing the end of my infectious diseases fellowship and I developed daily crushing headaches the centered behind my right eye. These headaches woke me from my sleep and were associated with nasal stuffiness and tearing in my eye. Aha, I had a new diagnosis… cluster headaches. At some point in the intervening years between childhood and fellowship, I had started taking Maxalt a few times a month for my headaches with some benefit. Now I was taking it 2-3 times a day with minimal relief. Finally, I could stand it no longer and I went to the emergency room seeking relief. I had a CT scan of my head which was essentially normal, and my diagnosis of cluster headaches was confirmed. I spent 6 hours in the emergency room and I was given no acute therapy for my headache. I merely received a referral to a neurologist, and a prescription for prednisone and verapamil (both meds thought to help cluster headaches, that I suggested to the ER doctor) for a few weeks down the line! Maybe I can see why persons might be looking for alternatives to “modern” medicine.

            I saw the neurologist a few weeks later who added little to my therapy, but did excise a $40 co-pay for his efforts. I half-heartedly took the prednisone and verapamil for the next few months and eventually tapered off these meds. Ultimately, my headaches returned to their normal pattern.

            My other maladies include bilateral heel pain diagnosed as plantar fasciitis by a podiatrist. After playing basketball, I would hobble around for several days walking like a gorilla on the outsides of my feet. I tried icing my feet, ibuprofen in mega doses, rest, and every brand of over the counter orthotic insert available, all without relief. In desperation, I even allowed fresh faced podiatry students to inject my heels with steroids hoping for improvement. Finally, I resorted to pricey, tailor-made orthotic inserts which I have worn religiously for the past 5 years. The inserts, made of hard plastic with a small amount of rubber cushioning over them, were made based on a mold of my feet designed to keep my feet in the “neutral position” according to the podiatrist. It sounded a bit hokey to me, but I have largely been able to return to my normal activities with the exception of running. Despite the success of the orthotics, I still have an element of heel pain that persists and basically rules out ever walking barefoot. Also, the inserts guarantee that no shoe will truly feel comfortable again. Imagine buying a nice cushioned pair of running shoes and then throwing in a couple of rocks before placing them on your feet!

            My third chronic complaint is my lower back. I know this is extremely common, largely because almost half my patients have the same complaint. My lower back is stiff in the morning when I get up and aches throughout the day. Having 3 young children doesn’t help. In fact, I can clearly appreciate my back aches worsening over the course of a long family vacation and improving when I return to work. I rarely have radiation of pain into my legs, but at times the back pain is quite limiting. I have resorted to stretching, something I despise. I have prided myself on being the least limber person in the world. I don’t think I have touched my toes since I was in utero! I live on anti-inflammatories. It is a wonder I haven’t bled to death from stomach ulcers. I wear a back brace when I play basketball and a sleep with a board under my mattress.

[tomorrow, am I losing my mind?]

The starting point (V of VII): A return to the Ivory Towers

     After 6 years in the Wilkesboros I uprooted my growing family, which now included my wife, Beth; two sons, Connor and David; and a dog named Jack. I accepted a 3-year position to specialize in infectious diseases at Case Western University in Cleveland, OH. Over the next 3 years, I was trained in a highly specialized field of medicine and I practiced in tertiary medical centers. My interest in alternative medicine took a back seat to the scientific method and evidence-based western medicine. I continued to watch with interest the public’s fascination with Echinacea, vitamin C, zinc, and other remedies to stave off colds and prevent disease.

            At the end of 3 years, I accepted a position at MetroHealth Medical Center in Cleveland. My primary role has been to teach medical students and residents evidence-based medicine. My focus is on infectious diseases, HIV care, and running the county tuberculosis program. You, the reader, are now just about caught up. I have just had my 43^rd birthday and I have finally gotten the gumption to start writing about my experiences. Although I can already look back on my life and see lots of accomplishments and adventures completed, I feel the creep of middle age. Will I ever get around to doing those big adventures I dream of… exploring the Amazon, hiking the Inca trail to Machu Picchu, visiting Australia and New Zealand, and returning with my whole family to West Africa? I feel the clock ticking, but I am unable (or unwilling) to go right now because all the responsibilities of life, primarily my job and my family, 3 young children (Thayer was born in 2007). I wonder if I will be healthy enough to do and enjoy these adventures 10-15 years from now. Some mornings when I wake up, particularly after having played basketball the night before, I am not sure my body will hold up. It seems my list of chronic maladies grows by the day. With this in mind I decided it was time to try something new (or should I say “alternative”?).            

            Here is my plan. In a city teeming with world class modern medical facilities: the Cleveland Clinic, Case Western/University Hospitals, and the MetroHealth Medical Center, I plan on shunning all that I have held as true and good in favor of the dark side!  Over the next two years, I will attempt to shed my cynicism and give “alternative medicine” a true chance. Equipped with an expansive guide to alternative medicine purchased by my wife at Barnes and Nobles, I will see if my maladies can be healed. I plan on trying a new discipline of “alternative medicine” each month and to record my experiences for posterity!

[tomorrow,  a listing of what “ails” me!]

The starting point (IV of VII): Appalachian remedies

       I accepted a job as a general internist in North Wilkesboro, NC, the proclaimed birthplace of NASCAR. North Wilkesboro and adjacent Wilkesboro are basically one town in the foothills of the Appalachians with a combined population of just over 7,000 persons. I anticipated that now that I was away from the “granola” crowd of Portland, OR and the tribal traditions of Ghana, I would no longer be exposed to alternative medicine. Boy was I wrong! The Wilkesboros opened up a whole new window to my thinking about “alternative” medicine. Now I got to experience “Appalachian” medicine (To be fair, the vast majority of my patients ascribed to traditional western medicine, but it is the exceptions that make for a good yarn!).

            There was a much loved elderly general practioner in town, Dr. Jack Dawson, who unfortunately succumbed to lung cancer during my first few years in North Wilkesboro. Since I was a new practioner in town and one of the few doctors accepting new patients, several of Jack’s patients ended up in my practice. As a result, I became familiar with several concoctions he had dreamed up which the local pharmacy happily compounded for his patients. Depending on a patient’s perceived malady, be it coughing with congestion, stomach upset, or nervousness, one could order up the appropriate “Dawson’s mixture”. I could literally write a prescription for Dawson’s mixture #1, #2, or #3 based on a person’s complaints and the pharmacy would provide the corresponding concoction. Believe it or not, I could even write a prescription for “Snakeoil,” another brew that Dr. Dawson had dreamed up and was highest in demand! To this day, I can’t help but chuckle when I think of Jack Dawson dreaming up a mixture and naming it “Snakeoil,” a name that has been used to belittle numerous “cure-all tonics” that have been peddled over the centuries with claims to fix all maladies (not unlike that which is being sold by the traveling vendors in Ghana in present day). Jack clearly had a sense of humor and for the most part his concoctions were relatively benign combinations of already available over-the-counter medications such as liquid diphenhydramine (the ingredient in Bendryl), milk of magnesia, and liquid acetaminophen (Tylenol), occasionally mixed with some stiffer substances such as bella donna or codeine. They appeared to cause no harm and the patients definitely imbued these concoctions with special healing powers that went above and beyond any of the individual ingredients.

            Aside from Dr. Dawson’s concoctions, I remember an elderly woman I admitted to the hospital with pneumonia. She was 92 years old and came into the emergency room clutching her own bottle of cough syrup brought from home. She swore that her cough syrup was much superior to the ones she might receive in the hospital. It ends up that her cough syrup was actually robitussin mixed with “white lightning” (another name for moonshine and a testament to the surviving illegal distilleries that still abounded in the region). I figured that she had made it past 90 years old, so who was I to deprive her of this apparently effective and calming remedy?

            There was also the woman who came to me from a nearby chiropractor. The patient informed me that she had hepatitis (inflammation of the liver). I asked her to explain the basis for this concern, as I could not appreciate any of the telltale signs of liver problems such as jaundice (yellowing of the skin), nausea, or abdominal pain. She said that her chiropractor had made this diagnosis and had sent her to me to have blood drawn to confirm the diagnosis. Needless to say, the tests all came back normal and I became somewhat wary of this chiropractor.

            On a regular basis, I was introduced to folk remedies and superstitions such as undecipherable herbal remedies and the healing powers of various floras. This reminds me of a little prank played on me by one of my patients. He noticed I was suffering from a cold with a runny nose. He pulled two buckeye nuts out of his pocket and told me that if I rubbed them on whatever ailed me it would get better. Thus instructed, I dutifully rubbed the nuts over my nose and sinuses. He than informed me that he was sure I would be feeling better soon because he had used the very same nuts this morning on his hemorrhoids and he was now free of pain!

[tomorrow… returning to the Ivory Towers]

The starting point (III of VII): A visit to the Juju priestess

     Villagers also sought care from the local Juju priestess who was rated as just "okay" according to Kwasi, one of our close friends. He said that she was a relatively weak Juju practitioner compared to the Juju priests in the neighboring villages. Women frequently sought the priestess’ assistance with the pains of labor and other maladies. In general, my interactions with her were limited, but once, Beth and I made a special trip to meet with her and get a better idea of what she was about. Kwasi, acting as our translator and guide, arranged a meeting with the priestess. We brought the recommended bottle of peppermint schnapps as an offering, and we were invited into the back of her house. She seemed quite amicable as she sat in the back of her small clay house with a corrugated steel roof. At the front of the room was a stool for her to sit on and a shrine of sorts littered with several partially or fully-emptied schnapps bottles. She guided us to some wooden planks serving as benches near the shrine.  Then, she sat down on the stool inches in front of us and began answering our questions while exchanging the required pleasantries. Beth and I both tested are rudimentary knowledge of the local dialect, Twi. In mid-conversation, she appeared to disengage and then she broke into a trance and developed a distant glaze in her eyes. She then threw white powder over her face and at us who were sitting uncomfortably close by. She began thrashing around with a machete while babbling unintelligible words. At this point, Kwasi discretely informed us that she was now possessed (not a striking revelation!). After a while, she calmed down, took a swig from one of the schnapps bottles, and returned to sanity. At this point, we nervously stood up and prepared to leave. She quickly jumped up and asked to have her picture taken with us. She also suggested that we proclaim our allegiance to one another at the next village gathering. I gave a tentative nod to this suggestion, and we made a hasty retreat.

            I was reluctant to publicly condone her practices to the village based on my brief interaction with her and also after having seen at least one case of negligence on her part. A few weeks prior, I had cared for a 14-year-old girl who was near comatose due to meningitis. The child had only been brought to me after having failed to respond to the ministrations of the Juju priestess! Fortunately, I managed to sidestep the whole ethical dilemma of supporting her for her practices via a public proclamation, and we managed to remain on good terms. She may not have been the most powerful Juju priestess, but I decided I would rather not take a chance of her spreading any bad juju in my direction. After 8 months in Ghana, I was ready to return to the high-tech world of modern medicine.

[Returning to the U.S. and “alternative” medicine in small town America…tomorrow]

The starting point (II of VII): Ghanaian medicine

     In the end, I was able to overcome all my fears and I truly fell in love with Ghana. Beth and I spent 8 months in Pramkese. Every one assumed we were married, although we weren’t. I worked in a small government health clinic and Beth, a lawyer by training, taught English to elementary students in the village school. I never had to do that emergency c-section, but I was introduced to several new forms of traditional medicine.

     At times, I felt as if I had been placed in a time machine and transported back 100 years to the pre-antibiotic era in the United States. While I diligently attempted to cure the ills of the villagers with my small armamentarium of antibiotics and western therapies, the general populace continued to seek “alternative” remedies. Even my medical staff was not immune to the lure of a street peddler who drove into town with a loud speaker on the top of his pick-up truck selling a “cure-all tonic” that purportedly was effective for piles (hemorrhoids), back pain, fevers, malaise, headaches, and more. To my astonishment, villagers emerged from the woodwork to place old bottles, cans, and plastic jugs in the bed of the peddler’s pickup truck to be filled with a dark brown concoction. I could not help but roll my eyes and give a look of dismay as my chief medical officer, Mary, who had trained in Germany, brought forward her own bottle to be filled. It would have been convenient to attribute this behavior of the villagers to poverty and it’s being too expensive to be seen in the Community Health Clinic, but I knew otherwise. It was well known that it cost only $0.25 to be seen by “the doctor” and that even this nominal fee would be waived if necessary.

While in Ghana, I cared for several other patients who came to me for a second opinion after traditional remedies had failed. One gentleman came to the clinic and complained of chronic pain in his right ear. He had tried several herbal remedies recommended by a local practitioner, but he was not getting better. With my otoscope in hand, I peered into his ear canal. To my surprise, his ear was jammed full of crushed herbs! After briefly irrigating his ear with some warm water, he was miraculously cured. This case and similar ones did little to bolster my faith in traditional healing methods, but I was also aware that I only saw the failures rather than the potential masses of persons who had been successfully cured by Ghanaian traditional healing.

[Stay tuned for tomorrow’s visit with the Juju priestess…]

The starting point (the first of seven daily entries)

            I am 43. Up until this point, my life has gone pretty much according to script. I grew up Gainesville, Florida, a small college town. I did my undergraduate work at Duke University in Durham, North Carolina where I was “pre-med” like the majority of students, although my major was in history. I graduated from medical school at the University of South Florida in Tampa in 1993, and I was accepted into Internal Medicine residency in Portland, OR at Oregon Health Sciences University. Both of my grandfathers were doctors, my dad is a doctor, I have an uncle who is a doctor, and several doctor cousins.  Suffice to say, I was not breaking any new ground. Family conversations were often spiked with medical doctrine.

            It was during my 3 years of residency and 1 year of chief residency in Portland that I was first confronted with “alternative medicine” as a plausible therapeutic option. The “left coasters” as we easterners call California, Oregon, and Washington inhabitants seemed to have more interest in alternatives to standard “western” practices. In the internal medicine clinic and on the general hospital wards, I was forced to consider the potential interactions and side-effects of non-prescription alternative meds. Ginko, ginseng, saw palmetto, and St. John’s wart were all the rage. Not to mention the Chinese herbal remedies brought by our Asian patients of which the ingredients largely went undiscovered.

            My schooling in “non-western” medicine continued during an 8-month stint in Ghana, Africa. How and why did I end up in Ghana, you might ask? I have had a lifelong fascination with Africa since watching, as a child, Mutual of Omaha’s Wild Kingdom hosted by Marlin Perkins. This interest was further sparked when learning about cool tropical diseases in residency. I spent my spare hours during chief residency plotting a way to spend some time in Africa prior to starting a real job. Being geographically challenged, like many Americans, while trying to arrange a position in Uganda I accidentally signed up for a volunteer position in Ghana. As you may know, Uganda is situated in Eastern Africa near the famed wild life reserves often seen on Wild Kingdom, while Ghana is far to the west.  Western Africa is most noted for the crush of humanity rather than the call of the wildebeest!  Fortunately, my geographical incompetence led to one of the best experiences of my life.

            I arranged a posting as a volunteer doctor in Pramkese. This is a small village of a few thousand persons in the south central region of Ghana, a temperate, previously forested region, just 6 degrees off the equator. After convincing my fiancée Beth to join me on the adventure, I began planning in earnest. I assembled my own library of medical texts on tropical medicine, pediatrics, obstetrics, and basic surgical techniques. I wanted to be ready for anything.

            An interesting aside… my fiancée, with whom I was “living in sin” according to her North Carolina relatives, sprung a zinger on me one evening in the weeks leading up to our departure. Just as I was pulling up the covers to my bed and snuggling into my pillow, Beth tapped me on the shoulder and produced some legal appearing documents. She and her mother had decided that it would be best if we were legally married prior to going to Africa in case any mishaps were to occur. In a moment of weakness, I agreed to what sounded like rational judgment. Of course, I woke up in the early morning covered with a cold sweat fearful that I may have signed away my bachelorhood. Who knows how my opinion of my fiancée would change while living in a remote village with no electricity? I begged out of the agreement the next morning, managing to keep my independence intact, much to the chagrin of my future mother-in-law.

            My preparations continued in anticipation of the big day. I learned how to prepare my own microscope slides to diagnose malaria. I beefed up my tropical medicine knowledge. My dad even gave me last second instructions on how to perform an emergent cesarean section! (Basically, throw some betadine on the mother’s abdomen, cut with scalpel, extract baby, and call for help).

[Stay tuned… tomorrow I am introduced to traditional Ghanaian medicine]