Update on my Exploration of Alternative Medicine

It has been two years since my last post. I am ready to climb back in the saddle and resume my exploration of alternative medicine. My goal is to eventually publish my experiences in a book. Over the last two years I have moved to Asheville, NC and taken a new job. I have explored Bikram (hot) yoga, barefoot running, and had knee surgery. There will be postings on these experiences later.
       Earlier this year, I summitted a proposal for my upcoming book to several agents. After a several month wait, I  came to an agreement with a reputable agent. Now, I am waiting to hear from a publisher. I have decided to resume this blog, but with a slightly different style. I am hoping for more reader interaction and comment. Please contribute. Your input will help guide which alternative therapies I try next.
       My next exploration will be to compare various performance drinks. With the help of my oldest son Connor, who turned 13 today, I devised the following plan: with your help I will pick 4 or 5 performance drinks and then compare their impact on my time trial performance of a 4.6 mile climb which I routinely do on the Blue Ridge Parkway. It is a well documented segment that has been mapped out on Strava. You can follow my progress on Strava, my facebook page, this blog, and my web page, www.explorationofmedicine.com. Once a week I will do this segment and post my results and thoughts. I will drink the tested performance drinks that you help me choose. My wife, Beth will serve me the drink in the form of a smoothy along with standard ingredients (frozen berries, orange juice, ice) in an attemp to keep me "blinded" from knowing what drink I am taking at that time. Only at the end of the experiment will it be revealed to me what I was drinking. I will perform the segment under the influence of each drink twice and also with no additive twice (the placebo).  Today, I will time myself on the segment for the first time to establish a baseline.
     Thank you for your suggestions and comments.

     

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]