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]