Archive for the ‘Internal medicine’ Category

Try all your pain relief options before reaching for ibuprofen

Friday, July 31st, 2015

FDA recall

I try to avoid fear mongering on my posts but I have been feeling a growing moral pressure to tell the new ibuprofen story for some time.  After reading how long term higher dose ibuprofen use can have the same heart attack or stroke risk as Vioxx, the time felt right to update you all on the issue.  Vioxx was banned by the FDA as unsafe. (The Lancet 2013 382:9894;746-8)

Ibuprofen (aka Advil©, Motrin© etc.) seems harmless enough.  Maybe you’ve worked out too hard, maybe you have arthritis, maybe bad period pains.  For many mild pain patients, this pill can be quite a satisfactory pain management tool. I have taken it myself occasionally.  It certainly is more forgiving than acetaminophen (Tylenol© and other brand names), where even one or 2 pills past the regular dose can land you in hospital with liver damage.

However what I see in my clinic is that people keep taking it.  They come to rely on it.  Some athletes and military personnel even call their daily dose of ibuprofen “Vitamin I”.  And like many chronic self-medicating patients, over time the dosage and the risks go up as the benefits diminish.  I see multi-year users describing how the pain goes down just a couple points, say from a 6/10 to a 4/10 yet when they started the drug totally eliminated the pain. So now they have all this risk just for a minor nudge of pain levels.  Not worth it.

They masked the pain and prevented themselves from learning about the cause and effect their choices had on their body.  If you can learn where cause and effect impact your life, your quality of life will blossom in many profound ways.

Basic common sense suggests that it is better to understand and change the root cause of the pain rather than trying to suppress it once injury occurs.  Working with a professional such as myself will allow you to identify why you have that inflammation so often – and no its probably not aging!  I discuss everything with patients from shoe choices to making sure you vary your workout routine based on your body type.  The treatments I offer can eliminate the need for the drugs completely and can even help with issues like weight loss.

Take the example of arthritis.  I will post more about arthritis later, but a sneak preview here is the fact that the bone changes themselves do not cause the pain directly.  Arthritis pain is now understood to be very complex, and involves changes to the immune and nervous systems.  Note that many people with the bone changes do not have any pain at all!  You cannot predict pain levels just from looking at an x-ray.  Obesity is ofetn the difference between pain or no pain.  Seeing me to kick the ibuprofen habit for osteo-arthritis allows you attack the reasons for the pain in a safe, controlled manner.

So what are the risks with ibuprofen?

Well for example, a dose of hard exercise normally causes minor intestinal tears in healthy people.  These tears usually heal up just fine.  But the ibuprofen makes them worse and can can even slow the repair, so over weeks and months you are causing quite a bit of damage.  Beyond the digestive damage directly, weakening the lining of the gut causes all kinds of other inflammation such as in joints or the heart, or blood vessels – especially those in the brain. (from “Medicine & Science in Sports and Exercise” December 2012 44:12; 2257-62).

The Physician’s Desk Reference 2015 lists several other issues.  Cardiovascular risk including stroke and heart attack.  Renal papillary necrosis (the tissue has died) and other renal injury leading to possible kidney failure, liver failure, blood pathologies.  All noted that risk increases with duration of use.

All of this risk is really quite unnecessary.  Call me, call your PT DC DO LMT etc. etc. and start living pain free without damaging your health.

I found this chart on Pinterest.  It is not complete, e.g. does not have the cautions about using if you are diabetic or asthmatic,  but I hope you find it informative.  (You have to click on it to see the detail…)

NSAID risk

 

 

 

 

Menopause Symptoms – they just don’t have to be that bad, because menopause is not a disease

Thursday, April 30th, 2015

Healthy older woman

I believe I have some good news for people struggling with this issue.  You don’t have to have the symptoms or at least the severity of the symptoms.

I have met many women who feel quite trapped by the situation.  They feel trapped between the choice having a low quality of life or feeling better with HRT but then having an increase risk of cancer later.  Or they feel somewhat hopeless against the power of family history and genetics.  They may not realize how much their own lifestyle choices can improve the problem.  They do not know that they have capacity to make changes for the better, as they are guilty about prior failures.

It is my opinion that menopausal symptoms like hot flashes, anxiety and insomnia, while common, are an abnormal response to a normal change.  This issue is not such a hard presentation compared to say blood loss – everyone with very low blood counts will feel awful.  But with hormones, a women with low numbers may not even notice anything.  Basically, issues like anemia are diseases, but menopause is not a disease.

For urban African and Asian women, only 40% have symptoms and a high proportion of these people do not report severe symptoms. 60% to 75% of Caucasian, urban Latin American and African American women report trouble and a high number have a significant reduction to quality of life.  Yet the actual hormone levels in different cultures are not significantly different over all.

I have seen daughters’ of really afflicted moms avoid trouble simply by taking better care of themselves and receiving treatment at my clinic.  Genetics may be the hand we are dealt, but how we play that hand is sometimes more important.

Western medicine does not have a clear definition of health in general practice.  They usually define health as an absence of disease yet have no measure of how hard the body is working to remain symptom free.  A person in balance has the metabolic resources to change without problems or without severe problems.  The idea of ‘balance’ and the Chinese Medicine view of balance relies on a personal relativity, which science as yet has difficulty studying.  Individuality by definition implies qualities not easily averaged.

But aspects of being in balance are making the news.   The home-based care advice given to patients for centuries in China and the last 10 years in Eugene by myself is, in the 21st century, now supported by the biomedical research.  You can play the game better, you can feel better.

Meditation in some studies knocks hot flash rates down 50%.  The presumption is that the thermo-regulation center in the brain is near to the brain areas reacting to adrenalin exposure.  Other practical methods of reducing adrenalin and stress help as well. Non-smokers or quitting smoking is a major factor.  Clearing excess alcohol and changing the standard american diet (sugar, fat, salt, caffeine) also improves outcomes in the research.

Now I must be cautious here – my reaction to remedies via lifestyle change is “Thank goodness the solution exists and it is all so simple” but many folk feel that the issues in the last paragraph are already major sources of guilt and an otherwise insurmountable obstacle. Try not to worry – I can help you make the process of change manageable and guilt free.  You may even become pleasantly surprised to find that even a 10-25% change is enough to get the job done and have a full night’s sleep, or the Chinese medicine is able to handle on it’s own.  In fact some patients only need to spend time and effort on the problem till the adjustment happens and then they don’t need the tools anymore – especially in cases where the symptoms arise because of the relative change of hormone levels, not the absolute blood levels.

Some women’s constitution may not even need the lifestyle adjustment.  Their system is strong enough that herbs or acupuncture alone is enough to leave the symptoms behind.  The simplest cases I have seen needed only about 3 weeks of acupuncture to get them feeling normal again.

As usual in my experience, and for regular readers of my blog, the best results in most cases happen when the problem is surrounded on many fronts.  Make a big impact on the system at the start, tail off as the problem fades.   Remember that menopause is not a disease and the annoying symptoms represent a difficulty adjusting to change.  Not many hot flashes can survive an onslaught of individually tailored herbs, acupuncture and adrenalin reduction.

 

 

Eugene allergy season – acupuncture wins over antihistamines

Tuesday, March 31st, 2015

Sneeze

Hello, Willamette Valley folks!  Allergy season is is already creeping up on us, and our valley seems to be a tough area for this problem. One of my patients today mentioned how a family member had to leave Eugene simply because of severe seasonal allergies, despite trying all the available drug options.  I have heard several of these stories during my time here.

Medications can help a lot of people, but their effect is is really only providing a holiday from symptoms.  I have never heard of anyone taking Claritin© during allergy season and then finding a lasting benefit if they stop in the middle of the season.  But I have frequently seen long term benefit when Chinese medicine was used.

I want to share an interesting research paper with you about acupuncture compared to Claritin©, also known as loratidine.  I like this paper because I think it has a very low probability of bias, and it looks at this question of lasting benefit.  The paper has some limitations such as not allowing for any individual variation in treatment for patients with different background metabolic situations, but it is from the Clinic of Otorhinolaryngology at the teaching hospital in Dresden, Germany.  The link to the article is posted below.

A teaching hospital has most likely seen many patients with bad reactions to drugs.  I looked loratidine up in the Physician’s Desk Reference and found over 80 adverse reaction warnings such as fatigue, dizziness, nausea, decreased libido, and incontinence of urine. These last 5 were some of the more intense symptoms I saw in my clinic last season caused by this drug. Also, many of you may have seen the recent news about how long term antihistamine use increases your risk of dementia. So this acupuncture research is really quite timely.

For those of you that are technically minded and are interested in the chemistry of allergic reactions, there are some lab test results in the paper that are worth looking at.  To keep it simple, let’s look at how the patients reported feeling after their treatment for allergies.  This study was actually looking at dust mite allergies but the physiology of seasonal allergies is almost identical, and with mites you can look at the effect of time without worrying about the change of season.

Sorry for the image quality here (this is a copy and paste straight from the paper) but I hope you can see a bar graph with red and blue columns.  Red is for acupuncture results, blue is for loratidine results.

Allergy bar graph

On your left side, you see how all the patients were feeling on the day after the last day of care, the right side shows how they were 10 weeks later.  87% of acupuncture patients reported improvement at the end of care, and 10 weeks later this was down to 80% of the patients.  So, OK, this acupuncture protocol did not work for every one but 80% after 10 weeks is still pretty good.

For the medication-only patients, on the day after taking their last pill 67% of them felt improved, but 10 weeks later none of the patients taking Claritin© were feeling any better; their symptoms had returned to pre-treatment levels.  After all the risk of side effects, none of the patients taking the drug felt any better after stopping the drug.

The doctors did not track adverse effects in this paper, but the number of patients in this study was not large enough to expect any dangerous adverse consequences of acupuncture, but would be large enough for drug side effects to be seen according to other research.

The moral of this story was that even poorly designed acupuncture treatments show a rather impressive result.  Bear in mind these patients were not offered any herbs or lifestyle/ diet modifications, and the treatments were not individually tailored to account for varying stress levels, other health issues, etc.  When I can treat with the full scope of my practice, surrounding the issue on many fronts, patients can see a benefit even a year later. And within 1- 3 seasons, they can find that they don’t need any further treatment of any kind.

Good luck this season!  And if you want to enjoy the outdoors without medication, give me a call.

 

 

The Effectiveness of Acupuncture Compared to Loratadine in Patients Allergic to House Dust Mites 

downloads.hindawi.com/journals/ja/2014/654632.pdf

Try this simple way to reduce colitis, IBS, weight gain, metabolic syndrome.

Friday, February 27th, 2015

Intestines

Emulsifiers may possibly be causing or promoting your symptoms, especially E466 (carboxymethylcellulose) and E433 (polysorbate-80).  See reference below.

Research findings in mice do not always apply to humans, and good science needs to reproduced independently before coming to firm conclusions.  But the latest research about emulsifiers in food suggests such a simple, cost effective diet change that I think we can try this experiment on ourselves.  Try a few weeks to months avoiding foods that contain either of these additives.  See how you feel.  You are at absolutely no medical risk if you try this, there is no nutritional value to these E numbers.  The only risk is you may have to change ice cream brand or similar.

This approach follows some very sensible advice  –

If you do not recognize the ingredients in the list on your packaged food or if they sound like chemical names, don’t eat it.

Follow this standard and with very few exceptions you will be eating whole foods.  While its possible that some additives are safe, the research is rarely sufficient for people at risk for inflammatory disorders.  The E numbers mentioned above have been “approved” for years but the fine, detailed research is obviously still happening.  Since these additives are not crucial to sustain life there is no real point in consuming them.  The take home message is that when it comes to the food industry, approval happens faster than research.

Reference:

Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome  http://dx.doi.org/10.1038/nature14232 

 

Working with babies, children and young teens

Friday, August 1st, 2014

Treating children with the respect that an adult expects –

Boundaries, guarding behaviors and earning a child’s permission to treat

I treat young people experiencing a wide range in the intensity of their discomfort.  Sometimes its a straightforward orthopedic case – say repeated ankle fractures from skateboarding or muscle strain from athletic training.  They can present as forward looking kids, motivated to get back to the fun and relieved to find someone who says they can help.  Or a bad flu – they are so symptomatic the child is ready to just have all the aches and pains all go away.

Other cases present with more significant issues about how they feel about their bodies and their stress. Sometimes, in a young body having trouble, there is a lot of guarding.  I see guarding presenting in many ways – the child may not want to show me where its hurts, they may switch to ‘wiggle worm’ mode and bounce around the office, they may not want to talk about anything at all.

At this point my first comments are commonly directed towards the embarrassed parent.  I say ‘Look, this behavior is ok.  Its just where they are at, and we’ll start from here.  My first job is to earn their trust.’   I engage with the child to see why they are behaving as they are, before I try to do anything about it.

‘Why is my child not ready to just lie down and receive treatment?’

In many cases of headache or belly pain, I commonly see that I am meeting the child after they have been through a very intense round of biomedical diagnostic procedures.  Scans in loud machines, invasive and painful scopes – it may have all been appropriate at one level (dangerous pathology does of course show up in children and we may need to screen for that), but it was not ok with the child.  With the best intentions, the earlier therapeutic relationships have been a source of wounding.  This is a point where it is often easy to earn trust – I simply promise not to do anything they don’t want me to.  No sudden surprise attacks with acupuncture needles like, say, an earlier vaccine experience.  I will ask a young child where it is alright for me to examine or to do gentle acupressure, and start there.

My most difficult case have rarely needed more than one or 2 sessions before I am trusted to apply any actual therapeutic techniques.  We may start with herbs, we may start with CranioSacral therapy or other bodywork techniques.  But once they experience that I am on their side, the child looks forward to sessions.

‘But what if my child really needs acupuncture specifically?’

Once trust is established, my pediatric training and experience has prepared me to engage with acupuncture in several ways.  Depending on the situation, I may let the child tap a needle into me to show it doesn’t hurt.  I may talk about what to expect, that they may feel a gentle pinch so I let them pinch me and then I pinch them gently to see what its like.  Often, once I have the child’s trust, I can use a needle at a point while I’m talking to them and they usually don’t even feel it.  Needling very young children (I have given acupuncture to young babies, days old) is simply a matter of lots of hand pressure around the area, a quick pop of the needle and then withdraw.  Very different than the adult approach of retaining the needle for 30 minutes and trying to get big stimulation.  With all of my techniques, the child usually loses interest in what I’m doing and falls asleep.

‘Is acupuncture safe for children and babies?’

The mainstream peer-reviewed pediatric journals regard properly performed acupuncture with children to be very safe.  I will discuss the literature in a later post.

 

 

Severe hayfever treated with great success

Thursday, July 24th, 2014

Multiple techniques make patients more comfortable, sooner

Some of my patients go through a lot of side effects with their allergy medication, for which the drug(s) does not work or at best only takes the edge off of the symptoms.  Fatigue, nausea, diarrhea, it just didn’t seem worth it for such little benefit.  They also report having tried ‘allergy shots’, or other alternative therapies like herbs and even acupuncture but nonetheless, the symptoms are still there, they live in the Willamette Valley ‘allergy megastorm’ and their symptoms are grim.  In difficult cases, I find one cannot always rely on a single treatment approach, that creating multiple influences on the body all at once acts as a catalyst, creates a synergistic effect that takes care of each factor that contributes to the problem. When you cover all the bases, the body can more rapidly adjust into long term clearing of the symptoms.

One diagnosis, many contributing factors

These cases can present with strong sinus headache, totally blocked nose, sore throat from mouth breathing, eye irritation, cough, social problems.  In my practice I find that a patient in this situation has many issues in the body allowing such strong symptoms.  The blocked nose can be due to or worsened by trigger points in the face and strain in the fascia relating to the mucous membranes.  Diet may be promoting metabolic activity that continually creates inflammation.  Life stress and adrenalin may be pushing the immune system into overdrive.

In the first visit, I evaluate these various types of factors and, together with the patient, create a set of therapeutic goals.  Each modality has overlapping effects but the basic outline could be as follows:

Trigger points are cleared with manual body work.  Life stress is calmed with CranioSacral therapy and acupuncture.  Herbs are provided to counteract the diet and reduce inflammation. Electroacupuncture is applied to reduce inflammation and rapidly open the nose so the person can breathe normally.

I have been practicing so long that I understand my tools, and in a 45 minute session can apply different procedures in a harmonious, smooth manner.  Most people just fall asleep on the table while I work, and afterwards find that they can breathe, that the itching is gone and that they can speak without throat pain.

The goal is to move towards a long term, stable clearing of symptoms.

Repeated treatments are given to make the effect last longer and longer.  The different contributing factors resolve at different rates, so the treatments change over time.  The complicated, multi-modal session I describe above eventually reduces to just one of the techniques, applied with decreasing frequency until no longer needed.  So just before ending regular care a patient may need an acupuncture treatment once every 6 months, or just need a $5 bottle of herbs to take a few days a month.  It does vary.  Often the results last into the next allergy season or longer.  From a biomedical perspective the allergy may still be detectable in blood tests (or not), but the body’s reaction to problem antigens has been successfully and stably eliminated.