From medical at olympus.net Thu Mar 6 11:24:42 2008 From: medical at olympus.net (Douwe Rienstra) Date: Thu Mar 6 11:25:12 2008 Subject: [Medicine-for-people] Evolution of a Doctor Message-ID: ========================================== Medicine for People! March, 2008 --------------------------------------- Contents Evolution of a Doctor - "We Loved Him Just the Way He Was" - Regrets and Objections - Finding Dr. Welby (Where You Wouldn't Expect) - The Kiss of the Spider Bite ========================================== "In the measure to which I think and speak not from my own individual conviction but simply repeating what 'is said' and 'is thought' my life ceases to be mine, I cease to be the supremely individual person that I am, and I act on society's account." Joes Ortega y Gasset (in my twenties, my favorite quotation) === Evolution of a Doctor === = "We Loved Him Just the Way He Was" = I am a young medical student at Duke University observing a team of pediatric cardiologists in the cath lab. A small, frightened child bawls. Beside him the pediatric cardiologist sits patiently with his stethoscope on the tiny chest. In the silence between the child's cries, he calmly describes the sounds made by this diseased heart. "A systolic murmur, loudest at the base, probably from the aortic valve. A constant murmur left back, probably a patent ductus arteriosus. Some stenosis of the pulmonic valve." I admire these pediatric cardiologists immensely, knowing I'll never attain their degree of skill. These guys really are exceptional. To pinpoint the defect, the doctors insert a catheter into the child's groin and thread it up to the heart, inject dye and take a very rapid succession of x-rays. The procession of film cassettes, each one a heavy metal frame holding a piece of X-ray film, sound like an airplane or a machine gun, a complicated loud chattering noise from two streams of film cassettes rattling down their metal tracks to the exposure points behind and beside the small patient. With the clattering beating around us, all eyes focus on the various monitors. Suddenly one monitor shows the heart rate dropping frighteningly, from 120 down to 80, to 60, then to nothing. Pushing the equipment out of the way, six doctors bend over the tiny body, calling for medication, pressing on the little chest, and glancing at the line staggering across the monitor. They work frantically to no avail. Finally they give up. The child is dead. I walk out in the hall with the cardiology fellow, a woman, whose job it is to take the terrible news to the parents. The mother is grief stricken. She sobs in the hallway. "I'm sorry, Mrs. Ashton, but we did everything we could." "Why did you do it? There was nothing wrong with him when you started." She is wailing, her sobs echoing down the hall. "Please, Mrs. Ashton, not so loud. His heart was diseased. He couldn't play, or run. Unless we discovered what was wrong and repaired his heart, he would never have grown up at all." "We loved him just the way he was, why did you have to do it? There was nothing wrong with him, he was good the way he was" I was used to seeing patients who stoically and without question accepted the doctor's wisdom; all this noise in the hallway surprised me and the cardiology fellow. All that I admired in the cath lab - the impressive X-ray apparatus, the high tech skills, meant nothing to this mother. As far as she was concerned, we'd killed her child. In the past 30 years since I stood in the hall listening to the mother's loud sobbing and sensing dimly that the balance between technology and humanity was out of whack, medicine has changed and I have changed. Sometimes people ask me how I came to be the independent-minded doctor that I am. In this month's newsletter, I tell about my medical evolution, starting with my beginnings as a young, wide-eyed idealistic newly-minted doc. = Regrets and Objections = For some time after I graduated, I regretted having attended medical school. True, the professors were usually dedicated and kind, but the system as a whole seemed lacking. How it seemed to me in the early 1970's was this: Doctor-centered medicine: For all my professors' curiosity and attention to detail, they did not always listen to what the patient was saying or appreciate what the patient was going through. Some people call this "medico-centrism," the idea that sick people eagerly await the doctor's next pronouncement and have nothing they'd rather do than agree and be grateful, regardless of any ill effects. Over-emphasis on technology: Here's an example. I could tell from a physical exam when a patient had pneumonia, but I was supposed to order a chest X-ray and blood tests anyway. Those tests can be lifesaving if a case is grave or complicated. They are not necessary in many cases I saw and still see on a regular basis. With my thrifty Dutch background, this lack of concern about cost to the patient bothered me. Inaccessibility and arrogance: My partner in Milwaukee made every patient who telephoned him at the office wait on the phone at least twenty minutes. We had five lines and all five buttons on the phone were usually flashing with patients on hold waiting to talk to him. Once on the phone, he spoke as if he had just come out of a burning building and had to go right back in again to save another life. About once a week he felt like chatting, so he'd come into my office, sit down and, despite the flashing lights on the phone, the full exam rooms, the full waiting room, talk as if we were on the golf course and he had all the time in the world. Whatever the reasons, doctors were in a hurry with patients, the result being an occasional missed diagnosis or ill considered treatment. All the expensive tests could not make up for this. Bias towards intervention: Although the physiology classes in medical school touched on the body's natural healing systems, these were often ignored when it came to treatment. In the delivery suites, for example, the process of birth was attacked as if the baby were an enemy who wasn't coming out without us going in after it. Narrow-mindedness: Mainstream medicine seemed arrogant. My professors expressed the opinion that no other medical methods were worthwhile, yet as far as I could see they knew nothing about botanical medicine, Native American medicine, Chinese medicine, or anything outside their own narrow sphere. Ignoring Self-Care: In mainstream medicine little attention was paid to the health of the physician. How, I wondered, could physicians help their patients with their mental and physical well-being when they paid so little attention to their own? And patients asked in vain for advice on how to take of themselves. Unless they were happy to pay to hear the doctor say "a healthy diet and more exercise," they were likely to be disappointed. = Finding Dr Welby (Where You Wouldn't Expect) = I came out of med school in the late 1960s, a time of reexamination of the previous generation's values and I was very much swept up in that rebellion. My disillusionment outlined above led me away from medicine for a time. I didn't want to use the cookbook given me in medical school. If I couldn't be Dr Kildare, Ben Casey, or Marcus Welby, I'd sail off into the sunset instead. You can read more about "The Long and Winding Road" in a previous newsletter (http://www.rienstraclinic.com/newsletter/2007/2007June.html). By the time I came back to medicine, I had learned to meditate and found it valuable. As Rabindranath Tagore writes, "The mind all logic is like the knife all blade. It cuts the hand that holds it." For me, meditation was a wonderful handle. Too, during my time off I'd done some reading about herbal medicine. I took some courses in polarity therapy, an early combination of Ayurvedic medicine and touch therapy. To my amazement, much of this had some beneficial effect, even for serious problems such as asthma. My friend Fritz Smith, MD, who practiced acupuncture, collaborated with me. He had developed his own technique of bodywork called Zero Balancing (http://www.zerobalancing.com/) and taught that to me. One evening in the hospital, a nurse complained about a severe back-ache. In a treatment room I gave her a five minute treatment that totally relieved her back pain. At the same time, I discovered a joy in using the skills I had learned in my training. I might not be Dr Welby, but I could do what was possible and bring comfort. I was drunk, both on conventional medicine and on all the new things I was learning. Rejuvenated, I recognized the rough jewel I had been given at Duke Medical School. = The Kiss of the Spider Bite = There was one major problem. The docs who hired me to join their practice were not similarly enthused. While one seemed interested in acupuncture and meditation, he thought I went overboard to recommend it to patients instead of anti-depressants or Valium. When I gave patients unconventional advice, they weren't happy. I remember one woman who came in with a red spot on her forearm. I questioned her, examined it, and told her that she had a spider bite. No worries, there was nothing we needed to do. It would go away on its own. She got angry and said "You mean I came in here and paid for your office call, and you're not going to give me any treatment?" I looked at her, I looked the bite, and I lifted her arm up and kissed the bite. Now, in this day of HIV and gloves on all the time, I know that sounds nearly suicidal. Back in those days, however, while we wore gloves for surgery, we didn't have all the infection control practices we have now. Anyway, the patient laughed, as I recall, and seemed content. Another time, a woman had a mild vaginitis. There was no evidence of infection, so I recommended a comfrey douche, something I'd seen work most of the time. She didn't have any access to comfrey, so I gave her my address and suggested she stop by and ask my wife to give her some from our garden. A day later the senior doc in the group called me into his office and fired me. He'd heard about me kissing the spider-bite, he was unhappy with my practice in general, and he was incensed that I had some teenager out at my house practicing gynecologic medicine without a license. Now, there was a simple explanation, but it took me a day or two to piece together what had happened. My wife and I were quite taken with meditation, so much so that we occasionally provided room and board for the local teachers and let them use our house as a meditation center. They had helpers to check the meditation practice of those who had learned. Having no study or other private rooms in our house, they used a bedroom to teach and to check meditation. One of those young helpers was checking meditation on the day my patient stopped by for her comfrey. She arrived to find the front door open and some people sitting on the couch, so she sat down too. The helper finished checking one meditator's meditation, walked her out from the bedroom, then beckoned to my patient, saying "come in, let me check you." The patient, by now probably wondering if a simple medical consultation had run seriously off the tracks, concluded the young man wanted to give her a pelvic exam in the bedroom. He looked about 18 years old, and she'd already had one today, thank you very much, and what the hell was going on here. She drove back to the office to explode about all this to the senior doc. Hence my getting fired. As it happened, a month later my senior colleague had a heart attack; they called me up and asked if I'd come back to work. Within days I was back to practicing medicine - my way, not theirs. This newsletter has already exceeded our usual length, so let's leave our story in Watsonville, California in 1975. Next month I'll share some more about my voyage though the jungles of alternative medicine, and how I came to the views and practices I use today. ========================================== === Recent issues of Medicine for People! === February, 2008 Diagnostic Testing; Healthy Lifestyle Support Group http://www.rienstraclinic.com/newsletter/2008/2008February.html January, 2008 Love Your Colon; Honor Your Anus http://www.rienstraclinic.com/newsletter/2008/2008January.html December, 2007 What I Learned in Jail http://www.rienstraclinic.com/newsletter/2007/2007December.html November, 2007 How to Talk to your Doctor, Winter and Vitamin D, Mercury-free Flu Vaccine http://www.rienstraclinic.com/newsletter/2007/2007November.html October, 2007 What is Science, Colon Cancer Screening Update http://www.rienstraclinic.com/newsletter/2007/2007October.html September, 2007 Perscription Medicines: When to Use them, When to Lose Them http://www.rienstraclinic.com/newsletter/2007/2007September.html August, 2007 Resist the Hype, Summer Scrapes http://www.rienstraclinic.com/newsletter/2007/2007August.html July, 2007 Annual Pharmacy Update, Free Pharmaceuticals, Medicine Far >From Home http://www.rienstraclinic.com/newsletter/2007/2007July.html ========================================== === Reader Alert === We publish this newsletter monthly. If you do not receive every issue, your spam filter may be intercepting it. Please add us to your email "accept list." ========================================== Medicine for People! is written by Douwe Rienstra MD, edited by Carolyn Latteier, and published at Port Townsend, Washington. Copyright March, 2008. To subscribe, click here: http://lists.olympus.net/mailman/listinfo/medicine-for-people To change your email addresss, go to http://lists.olympus.net/mailman/listinfo/medicine-for-people to subscribe using your new address. Unused addresses are removed automatically. Click here: http://www.rienstraclinic.com/newsletter/archive.html for previous issues. Write Dr Rienstra here: MedicineForPeople@RienstraClinic.com. More information about the clinic: http://www.rienstraclinic.com/ From medical at olympus.net Wed Mar 19 14:15:08 2008 From: medical at olympus.net (Douwe Rienstra) Date: Thu Apr 3 07:43:39 2008 Subject: [Medicine-for-people] Integrating Western and Alternative Medicine Message-ID: ========================================== Medicine for People! April, 2008 --------------------------------------- Contents Integrating Western and Alternative Medicine - Conventional Western Medicine - Alternative Medicine Defined - Alternative Schools of Medicine - Integrative Medicine - Coming Next Month ========================================== === Integrating Western and Alternative Medicine === "In the measure to which I think and speak not from my own individual conviction but simply repeating what 'is said' and 'is thought' my life ceases to be mine, I cease to be the supremely individual person that I am, and I act on society's account." Jose Ortega y Gasset In last month's newsletter I related my youthful doubts about mainstream western medicine and told how I became interested in alternative medicine. The Orgeta y Gasset quotation above, lauding independent thinking, was my favorite at that time. Since that time, I have studied a number of alternatives and have integrated the best methods from many of them into my practice. I may have been early out of the gate, but in the last 15 years, alternative medicines have begun to gain respect. In 1991 Congress established the National Center for Alternative and Complementary Medicine (http://nccam.nih.gov/ ), a branch of the National Institutes of Health, to provide information and encouraging research on alternatives. This month, I'll give a brief survey of the various alternative schools with their pros and cons. = Mainstream Western Medicine = Mainstream medicine comprises methods developed in academia, approved by the government and by insurance companies, and practiced by most licensed physicians. As you know from previous newsletters, there is much to criticize in mainstream medicine, but let me here point out some advantages. 1. While fads (freezing the stomach in the 1950's, excessive hysterectomies in the 1960's, excessive statin use currently) occur regularly, eventually someone does a study to show the error. Scientific studies constantly scrutinize medicine, so that our ability to keep people alive and improve the quality of their lives increases all the time. 2. Say what you will about mainstream medicine, few people wake up at 3:00 am with agonizing abdominal pain and call their chiropractor. Run over by a truck, they don't think acupuncture. For 99 percent of the population, mainstream medicine is the court of last resort. 3. If you want "fast, fast, fast relief" mainstream medicine is your horse to bet on. Just make sure it doesn't step on your foot. = Alternative Medicine Defined = People get confused about the terms alternative, complementary, and holistic medicine. Here are the definitions: --Alternative medicine (http://en.wikipedia.org/wiki/Alternative_medicine) is as any healing method not associated with mainstream medicine. --Complementary medicine uses non-mainstream methods to complement mainstream medicine. --Holistic Medicine (http://en.wikipedia.org/wiki/Holistic_medicine) concentrates on the spiritual side of medicine, while using alternative or mainstream techniques depending on the training of the practitioner. = Alternative Schools of Medicine = The following are some of the different schools of alternative medicine, most of them readily available locally and nationally. Naturopathy http://en.wikipedia.org/wiki/Naturopathy Naturopaths seek to understand and enhance the healing processes in the body, employing botanical, nutritional, homeopathic, and other methods. They have successfully petitioned Washington State to allow them to prescribe antibiotics. A naturopathy license requires a college degree followed by a four year education that includes biochemistry, anatomy, physiology, and many other traditional medical courses, as well as courses in non-pharmaceutical medicine. I've met and learned from some very capable naturopathic physicians, and many of my patients are the better for it. The naturopathy profession correctly recognizes that they still lack the competency-intensive residency programs that turn green medical school graduates (who have their MD, but little front-line experience) into responsible, team-aware physicians. Chiropractic http://en.wikipedia.org/wiki/Chiropractic Traditionally, chiropractors relieved musculoskeletal pain by manipulation of the tissues and joints. Some chiropractors combine traditional chiropractic with nutrition and physical therapy techniques. Back in 1975 when I worked in Pacific Grove, California, I walked into a chiropractor's office, introduced myself, and asked what he could tell me about chiropractic. In answer, he set me on his table and, to my surprise, twisted my neck quickly to one side, then the other, producing a series of cracking sensations. It did not hurt, nor did I feel any better than before. I know he meant well, but that particular maneuver has a six in 100,000 chance of causing serious harm. Although some chiropractors claim to be "family doctors," they really cannot replace a family physician. Their training just doesn't stand up to the task. Not all chiropractic colleges require even an undergraduate degree for admission. Chiropractic programs require four years of study and practice. Acupuncture http://en.wikipedia.org/wiki/Acupuncture When most Americans think of Chinese medicine, they think acupuncture. However, traditional Chinese medicine (TCM) (http://en.wikipedia.org/wiki/Traditional_Chinese_medicine) has included internal medicine, surgery, and many other techniques not usually offered by Chinese medicine in this country. Contemporary Chinese physicians use modern pharmaceutical and surgical techniques alongside the traditional methods. Chinese medicine postulates energy channels (called meridians) through the body. Acupuncture works to influence these channels using needles or heated herbs (moxibustion). I've known patients with sleep disorders and addiction problems to have success with acupuncture, but the results are not consistent. Success seems to depend very much of the individual practitioner. The patients who rave the most to me about Chinese medicine go to Chinatown to get it. Herbalism http://en.wikipedia.org/wiki/Herbalism Leaving aside shamanism, herbalism must be the oldest form of medicine on this planet and it is still used effectively today. English physician William Withering (http://en.wikipedia.org/wiki/William_Withering) entered the history books thanks to his observations and deductions regarding the traditional herbal remedy foxglove, source of the heart medication, digitalis. Know anyone with breast cancer? There's a good chance they were treated with paclitaxel, from the Pacific yew tree. Today, you can go to Oxford University in England and study herbalism to the PhD level. Unfortunately, around 1911 mainstream medicine, with corporate help, succeeded in ending such education in the United States. (See http://www.rienstraclinic.com/health_info/politics/abraham_flexner.html ) As a result, there are very few well-trained herbalists in the United States. Most are self-educated with predictably variable results. Homeopathy http://en.wikipedia.org/wiki/Homeopathy Homeopathy, "like cures like," is based on the theory that if something causes a symptom at high doses, it will reduce the symptom if given in vanishing small amounts. I recall one research study reporting a benefit for allergic rhinitis, but in most studies homeopathy appears to have only a placebo effect. As with herbalism, there are no credentialed schools of homeopathy. I've heard stories of success and failure from patients. Of everything mentioned here, it is least likely to cause harm. Ayurvedic Medicine http://en.wikipedia.org/wiki/Ayurveda Ayurvedic medicine recognizes that people come in differing psycho-physiologic types, and tailors remedies to each individual. In 1987, the Transcendental Meditation organization offered a course in ayurvedic medicine near New Delhi, and I decided to take it. While Indian schools of ayurvedic medicine require over five years of study, our course was only a month in length. The course was heavy on theory, light on practice. I took several supplemental courses after my return to the US. There, I learned some valuable concepts and gained more respect for fully-trained ayurvedic physicians. Recently, about 20 percent of ayurvedic herbs brought into the US were found to contain mercury and other heavy metals; ayurveda believes these to be important remedies. On the other hand, an Indian organization successfully overthrew a US university's patent on a potent traditional medical herb, arguing that ayurvedic doctors had known the benefits of and used this herb for centuries. I think a skilled ayurvedic physician who had also been through a complete mainstream medical training would be able to learn how to integrate the two, and teach the rest of us. The same holds true for chiropractic, TCM and herbalism. Osteopathic Medicine http://en.wikipedia.org/wiki/Osteopathic_Medicine Originally, osteopathic medicine focused largely on manipulative methods. Over time, osteopathic medical schools became almost identical to medical schools, with the addition of manipulative techniques to the curriculum. Upon conferral of the DO (Doctor of Osteopathy) degree, students enter residency programs where they join MDs for specialty training. State licensing authorities correctly treat osteopathic doctors as the equivalent of MDs. Indigenous Medical Systems Aside from traditional Chinese medicine, herbalism, and Ayurvedic medicine, there are numerous other indigenous systems, including Islamic medicine (http://en.wikipedia.org/wiki/Islamic_medicine). Moslem scholars preserved the writings of the ancients, including Galen and Hippocrates, and gave us great physicians of their own such as Avicenna (http://en.wikipedia.org/wiki/Avicenna). Today botanists scour the rain forests looking for undiscovered medicinal plants, and the indigenous knowledge of their use. = Integrative Medicine = If we're really in trouble, most of us - myself included - turn to western medicine for help. But the very fact that pharmaceutical companies send botanists out to interview indigenous healers in the rain forests, that ayurvedic doctors successfully sued for patent infringement, and that herbs like foxglove are the foundation for potent western medicines, tells us that the alternatives have much to offer. Western medicine would do well take a dose of humility and keep its mind and its eyes open for every possible way it can help and heal. Having spent over three decades involved in botanical medicine, ayurvedic medicine, naturopathic medicine, traditional western medicine, etc, I prefer to evaluate each individual, discuss the options, and work out an individual treatment plan. This process, integrating western medicine with other schools, is called Integrative Medicine. And just as every school of medicine can be improved, we ned to appropriate the best of each school--what it can be, not just what it is. As Arnold Relman, past editor of the New England Journal of Medicine pointed out, "There is no such thing as alternative medicine. There is medicine that works and medicine that does not work." = Coming Next Month = Medicine for People! has not been shy about identifying the warts in mainstream medicine. Next month we'll point out some pitfalls in alternative techniques, especially those designed to entrap desperate folks with promises of magical cures. We've covered this slippery slope previously in Mexican Yam "Hormone Substitute" http://www.rienstraclinic.com/health_info/hormones/yam_scam.html Multi-level Multiple Vitamins http://www.rienstraclinic.com/newsletter/2002/2002Nov.html Coral Calcium http://www.rienstraclinic.com/newsletter/2003/2003May.html Supplement Quality Ear Candles http://www.rienstraclinic.com/newsletter/2002/2002Oct.html What is Science? http://www.rienstraclinic.com/newsletter/2007/2007October.html Stay tuned next month for my "Alternative Medicine Hall of Shame." ========================================== === Recent issues of Medicine for People! === March, 2008 Evolution of a Doctor http://rienstraclinic.com/newsletter/2008/2008March.html February, 2008 Diagnostic Testing; Healthy Lifestyle Support Group http://www.rienstraclinic.com/newsletter/2008/2008February.html January, 2008 Love Your Colon; Honor Your Anus http://www.rienstraclinic.com/newsletter/2008/2008January.html December, 2007 What I Learned in Jail http://www.rienstraclinic.com/newsletter/2007/2007December.html November, 2007 How to Talk to your Doctor, Winter and Vitamin D, Mercury-free Flu Vaccine http://www.rienstraclinic.com/newsletter/2007/2007November.html October, 2007 What is Science, Colon Cancer Screening Update http://www.rienstraclinic.com/newsletter/2007/2007October.html September, 2007 Perscription Medicines: When to Use them, When to Lose Them http://www.rienstraclinic.com/newsletter/2007/2007September.html August, 2007 Resist the Hype, Summer Scrapes http://www.rienstraclinic.com/newsletter/2007/2007August.html ========================================== === Reader Alert === We publish this newsletter monthly. If you do not receive every issue, your spam filter may be intercepting it. Please add us to your email "accept list." ========================================== Medicine for People! is written by Douwe Rienstra MD, edited by Carolyn Latteier, and published at Port Townsend, Washington. Copyright April, 2008. To subscribe, click here: http://lists.olympus.net/mailman/listinfo/medicine-for-people To change your email addresss, go to http://lists.olympus.net/mailman/listinfo/medicine-for-people to subscribe using your new address. Unused addresses are removed automatically. Click here: http://www.rienstraclinic.com/newsletter/archive.html for previous issues. Write Dr Rienstra here: MedicineForPeople@RienstraClinic.com. More information about the clinic: http://www.rienstraclinic.com/