Managing Chronic Pain

Despite the media hype of books that promise to “banish your pain,” the reality is that chronic pain is just about impossible to extinguish, whether in “five simple steps,” “four quick weeks,” or whatever the latest tantalizing promises are. The truth, as you probably know if you have been experiencing chronic pain, is that the goals of controlling, managing and living  a satisfying life with pain are much more realistic. As both a person who lives with chronic pain and a medical writer, I have come across a useful website with a realistic, helpful approach to  chronic pain. Full disclosure: I have written some articles for this site, in consultation with several reputable medical professionals. In so doing, I have come to respect both the source of the information and the approach of the site. I have also learned a great deal.

The site is painAction.com, and here are some of the articles I wrote, although I recommend reading any others on topics that are of interest! The site covers back pain, migraine pain and cancer pain, and includes articles, lessons and interactive tools. The focus is on developing skills in self-management, gathering knowledge, medication safety, working with  health care professionals, communication and  emotional coping. Given my interest in integrative medicine, I am also pleased to report that there is information on alternative/complementary modalities to manage chronic pain.

Healing the Soul: Shamanism and Psyche

Do you ever feel in the grip of anger, fear or sadness that are sometimes triggered by  seemingly trivial events? That perhaps well up in you from the depths of your childhood and are sometimes powerful enough to cause health problems related to stress and tension? Psychologist Ann Drake, PSy.D., opens her book, Healing of the Soul: Shamanism and Psyche (Revised edition,Busca Inc., NY. 2009) with a challenge to readers:

Join her in her struggle to understand mental and physical illness in new ways that lie outside of the Western way of understanding. She invites us to ponder existence from new and varied perspectives, to take what makes sense, validating it with our own internal wisdom, and, finally, to create our own meaning.

What are these new perspectives? They include seeing how energy, spirit, and psyche interface to create the unique psychological reality of each person. Drake is a scientifically trained practicing psychologist who has devoted her career to finding the connections between the conventional practice of psychotherapy and the ancient healing practices of Shamanism—which holds that the loss of part of one’s spiritual essence or soul, often happening as the result of childhood trauma, can result in psychological pain and even physical illness. For many years she has studied Shamanic practices with a Bomoh—an indigenous healer—in Borneo, bringing back new and deeper understanding and skills to add to her psychology practice.

While cognitive therapy focuses on the rational aspects of the mind, Shamanic healing enters a deeper, energy level. Describing powerful stories of healing the “inner worlds” of her clients, Drake says, “Many of us find ourselves stuck in images and feelings from childhood. These images and feelings create an energetic imprinting.  The hurtful, rageful words of a parent stick to a child’s energy field as if to Velcro, haunting the child [and persisting as the child grows into adulthood] with feelings of shame and inadequacy….” Blockages to the removal of this harmful energy persist in our habitual ways of thinking, says Drake. But Shamanic  work [which focuses on the flow of energy] can remove these blocks and restore the soul to wholeness and the body to health.

This book is an excellent introduction to the potential for deep healing and the alleviation of suffering by combining the science of psychology with the mysterious world of the soul.

Swine Flu: Prepare, Protect, Pull Through

I asked integrative physician Alexa Fleckenstein, M.D., how to protect ourselves from swine flu, and what to do if we get it. Here is her response: NOTE: Advice on this blog in no way replaces consultation with a physician. Always consult with your doctor before following online advice.

“So far, I think we are dealing with an epidemic that has not the makings of the pandemic of 1918/19 where young people died in droves, often within the first 24 hours. Still, the elderly and immune-incompetent patients might be at risk. The causes of death in influenza are of two different origins: Older people die of the virus and its consequences like pneumonia; their weakened immune systems cannot fight the virus anymore. Young people succumb to an overreaction of their still-exuberant immune systems. We call this a cytokine storm, usually within the first two days.
“If you get seriously sick, consult a physician.  Officials recommend Tamiflu (oseltamivir, a neuraminidase inhibitor) but there are no good studies for the swine flu and Tamiflu. Against regular influenza A and B, Tamiflu’s performance has been rather disappointing – especially in the elderly, who would be prime targets for the drug. In addition, a tendency to suicide has been reported with Tamiflu in Japan – so bad that its use is discouraged in young people under 19. Furthermore, in case of an epidemic, Tamiflu might be in short supply.

“So, let’s look into some simple natural remedies – this is what I do for myself and my family:
The Three P’s: Prepare, Protect, Pull through.
Prepare: This website is all about owning your good health. If you have used the Five Health Essentials (water, movement, food, herbs, order) you should be in good shape to start with. If not – it is never too late to start cold showers and get plenty of sleep.
For those may be new to the topic, here is a summary of the  Health Essentials:
- End every warm shower or bath with a cold shower. This increases immunity.
- Drink enough fluid, hot or warm water — about seven glasses per day; more if you exercise. Herbal teas are good; juices are not.
- Eat as healthily as you can with vegetables (cooked and raw), mushrooms (never raw!) fruit, nuts, whole grains, legumes (beans, lentils, garbanzos) and fish. Cut down on meats and buy organically whenever possible. Stop eating processed, artificial, canned, micro-waved and fried food. Avoid sugars, white starches and dairy altogether. Only with healthy fare is your immune system able to fight the invaders.
- Exercise moderately. Excess is as detrimental as laziness. If you are still a couch potato, now it is time to change your ways. Start with two minutes a day on any machine that is gathering dust in your basement. Or make it a habit to go for a walk every day for 10 minutes (You may do more — but not less).
- Expose yourself to light daily. Light (not direct sun) is beneficial for your immune system. Against direct sun, wear sunglasses, a hat and long-sleeved garb.
- Get enough sleep. We come down with a cold if we are run down. Don’t set your body up for a catastrophe: Go to bed between 9.30 and 10.30 pm. The body repairs itself during about two hours the time around midnight — if you are asleep then, that is.
- Take tonic herbs like astragalus, ashwaganda and Eleuthero to strengthen your immune system. Rotate them.
- If you are not eating mushrooms often, take a mushroom supplement (shiitake, reishi, maitake — either one is good alone or in combination).

“Protect yourself during an outbreak: Continue your good work from the ‘Prepare’ section and:
- Avoid crowds, public transportation and all unnecessary contact with people. Whenever you meet people, wear a surgical mask or a light cotton cloth over nose and mouth, sprinkled with a drop of essential oil like eucalyptus, oregano, myrrh. Or smear a pea-sized glob of Vick’s on it.
- Don’t hug, kiss or shake hands
- Avoid touching public doorknobs or surfaces with your ungloved hands
- Wear gloves in public; wash them often. Wash hands often with soap and water
- Gargle frequently (hourly) with a mouthwash or a tea made from sage. I like 1 drop of tea tree oil in a glass of lukewarm water.
- Rinse your nose frequently (hourly) with saltwater: 1/4 teaspoon of sugarless salt in one glass of lukewarm water. Snuff the water up from your hand; use a dropper on little children.
- Spice up your food with herbs and spices because they kill microbes (the plants developed the strong-tasting compounds to protect themselves against the invasion of bacteria, viruses and fungi). Pregnant women and little children should go easy on herbs and spices.
- Take a teaspoon of raw honey after exposure. Not for children under two years because of the danger of botulism.
- Nibble on cloves of fresh garlic throughout the day, especially when you are out and about. Use garlic (fresh or dried) freely in your cooking. Same with onions.
- Use an Echinacea throat spray every hour, or swish three drops of Echinacea in your mouth (contraindicated in autoimmune disease).
- Chew on juniper berry. Add one berry every day, up to five, then take one away again every day. This is the formula: 1-2-3-4-5-4-3-2-1. Not recommended in kidney disease.
- Sleep a lot, do meditation, be quiet and do something that lifts your heart – like making music, painting, gardening. Find your center.

“Pull through: If you become infected, go to your doctor and ask about the following suggestions: Continue most of the measures from Prepare and Protect — but stop all exercise. Now is time for bed rest.
- With the first symptoms take the Chinese preparation Yin Qiao (later it is no longer useful ) (three tablets four times a day). After you feel improvement, take one tablet three times a day for another week
- Avoid all contact with others to not spread the disease.
- Continue taking garlic, Echinacea and honey. Add of these herbs (whatever you have at hand: Andrographis paniculata (or any combination preparation that contains it – like GAIA’s Qick Defense), GSE (grape seed extract), ginger (fresh and dried — avoid preparations with sugar), elderberry, licorice (not longer than a week).

- Herbal teas to relieve your symptoms: linden, elderberry flowers (both induce sweating), sage, green or black tea, thyme, ginger, rose hips, mullein, lemon balm, peppermint in all combinations.

-Steam inhalations three times a day with chamomile, thyme, eucalyptus or Vick’s help congestion of sinus and lungs. Horsetail can be added to decrease swelling in your nose.
- Chicken soup and hot lemon are still beneficial.
- Take fish oil (several capsules a day — contraindicated if you take anticoagulants like coumadin). This is the one thing most important in young people as it might be able to douse a raging cytokine storm. Alternatively, or in addition: the anti-inflammatory medication Zyflamend.
- Ginkgo biloba will start repair damaged cells
- Ginseng will help flu symptoms — but do not take it if you tend to have high blood pressure or a racing heart.
- At least twice a day, have somebody wash you down with cold water (non-dripping face cloth), especially chest and back area to make you take in really deep breaths (prevention of pneumonia)
- Against cough: Gan Mao Dan Chinese pills (20 per day in divided doses), or make a tea of peppermint, honeysuckle, ginger, cloves and horehound.
- Other herbs that have been found beneficial in colds and flu: bayberry, boneset (Eupatorium perfoliatum), calendula, goldenseal, Oregon grape.

By no means are these all possibilities. But they give you some ideas and some peace of mind in case of an epidemic. Don’t become a victim – work with the three P’s!”

Alexa Fleckenstein, M.D.

Stunning View of Pregnancy

Watch the astonishing development of the baby, week by week during pregnancy, through the remarkable “eyes” of ultrasound. Here is a a stunning collection of moving and still pictures of the growing baby in this new YouTube video based on the recently released Harvard Medical School book, Your Developing Baby.

The Medical System Gave Up On Me

In 1995 I woke up from routine heart valve surgery with the left side of my body paralyzed from a stroke caused by the surgery itself: A tiny piece of tissue had broken away from the valve, traveled through blood vessels and lodged in my brain, blocking the flow of blood with its essential supply of oxygen to the neurons that controlled movement on my left side. I was 43 years old, married, with two young children.

If I had obediently followed the prescribed role of stroke patient in the world of conventional medicine, I would be an invalid in a wheelchair today. Instead, I am back at work as a medical journalist, paying taxes instead of collecting social security.

I recovered because “adapting” to my disability — which is what the insurance company doctor (who had never met me) told me to do after two months of occupational and physical therapy — was not an acceptable option for me. I didn’t want to buy shoes with Velcro, buttonhole fasteners or devices to hold a tomato steady so I could slice it. I didn’t want to walk with a cane or use a wheelchair in the airport. And I certainly didn’t want to spend valuable recovery time learning to use adaptive devices.

During my recovery, the health providers whom I found most helpful were those who recognized the devastation and despair that I felt as the result of this physical calamity. They saw me not just as a patient, but also as a wife, mother, writer and even amateur musician. In their understanding I found the encouragement, strength and hope that I needed to fight back to recovery.

The doctors I found least helpful were those who saw me not as a whole person, but rather as a “stroke patient:” These included the neurologists who shrugged and said “wait and see” when I told them that they must be wrong: I needed my left arm and I needed to be able to walk; and the heart surgeon who breezed into my hospital room just long enough to say, “Sorry you stroked, but heart-wise you’re fine.”

I quickly learned that while the advances of modern surgery can save your life, the conventional medical system — along with the insurers who pay for it — is not set up for full recovery.  The goal of the system was to get me out of the hospital or rehabilitation facility and send me home. What happened after that was up to me. The insurance company doctor (the one who never met me) told me that I had “plateaued,” which meant that while I had made progress in physical and occupational therapy, there would probably be no further improvement. I was at an impasse and additional intervention would be counterproductive (not to mention expensive).

As a patient, it feels as if the health insurers and many doctors want us to accept and “adapt” to our disabilities — whether we are recovering from a heart attack or stroke, suffering from chronic illness or pain or trying to manage the difficulties of growing older.  It is easier to prescribe pills and adaptive devices than to help us take responsibility for our bodies and our health.

I chose to fight my way back to recovery, and this is a tough thing to do for those of us who are accustomed to seeing our doctors as omniscient beings who control our health.  I learned about methods of healing outside of mainstream conventional medicine,including Traditional Chinese Medicine, chich has used acupuncture for thousands of years to treat stroke patients . Yoga, from the equally ancient Indian Ayurvedic system of medicine, gave me strength, balance and peace of mind. The Alexander Technique — a powerful system of movement education — taught me to use my body with less effort and reduced pain. Pilates exercise coaxed my weakened muscles back to work and craniosacral therapy restored my body’s natural rhythms.

I was fortunate: I had the will, the family support, the research skills and the financial means to pursue unconventional healing methods. Fighting the system is much harder for those who don’t have the money, the knowledge of alternative therapies or the emotional strength to keep up the lonely struggle for recovery.  Too often, such people live with pain, disability and despair.

Doctors must understand what illness means in the lives of their patients. They must use their positions, their authority and their words wisely. They have the power to heal, but they also have the potential to destroy hope and, along with it, the chance to recover.

Celebrate World Water Day!

Today is the day to celebrate water, not only the health benefits it gives us through cold showers, but also as the precious wellspring of life itself. Here is a true story about  water in the world, written by Alexa Fleckenstein, M.D., author of Health 2 0.

Turkey, 1970. A young American couple and a Turk at a small wellspring – a trifling rill of water in a vast land of rolling hills covered in ochre gravel and brown dried brush.

The Americans, with their feet in a muddy puddle that sends that paltry rivulet trickling down the hill, are shampooing their hair. They are laughing, trying to engage the Turk with their friendliness. “Su! Su!” says the Turk. He is tiny compared to the strapping young couple, and I suspect he is not as old as he looks – aged before his time as people are who live in arid regions. The Americans listen good-naturedly and seem to enjoy his funny gesturing. They are now rinsing their hair in the runnel that percolates meagerly from the rocks above.  They laugh about the funny situation: Here they are standing in a foreign country, not speaking the language, with soap in their hair, trying to comprehend the excited babbles of a little man. “Su! Su!” he says again. What they want to know from him is: Does he have a decent faucet at home to get rid of the shampoo?

“Su! Su!” the Turk urges again, pointing  down into the valley and back to their feet, and down again. I  happen upon the scene with my traveling companions and I cannot understand his words either. I do understand, however, the agony in his eyes and his gestures: The soapy run-off flowing downhill is no broader than my finger– and it is the only source of water for the man’s village!

Never have I forgotten this picture: those friendly Americans, oblivious to the impact of their doings on the rest of the world. By some quirk of fate, I have become an American myself and have found happiness and opportunity and heart-warming friendship in this country.

The Turk’s agony and my German upbringing conspired: Water has become an important focus of my life – and of my work as a physician. In my youth, everybody took a short cold rinse after each warm shower or warm bath – to “close the pores.” I grew up washing my face with cold water only – and never with soap. Cold water promoted health and beauty, that’s what I learned early on. But then I came here, and the suggestion to use cold water only produced a mocking shiver from my patients: Who would use cold water if they could have it warm?!

A lifetime later, we all have learned that popping pills is not the answer to many of our “civilized” diseases, and even something as outlandish as cold water seems reasonable – especially if backed up by modern research: Cold water is an important stimulus for our over-coddled immune system. Back in the times when we dwelled in caves and roamed the savannah, cold helped us move around and fight diseases, as unlikely as it might sound at first.

There is no life without water, and the benefits of water on health are myriad. Unfortunately, we will have water only if we learn to view it not as the cheap stuff flowing from the tap on demand, but as the precious, sacred wellspring of our lives.

Americans are living off the rest of the world, blithely unaware – and water is only one of the precious resources that we squander thoughtlessly. From 1985 to 1995, the UN had declared a Decade of Water. That effort went by, unheard, unheeded here – just like the Turk’s cry for “Su! Su!” – “Water! Water!” at that encounter around the dribbling well. Since 2005, another Decade of Water is underway, again mostly ignored here.

There’s very little ill will in this country but plentiful lack of information and education. Americans don’t understand why they are so much hated in the world. The world sees them thus: Good-natured and friendly Americans – outsized kids – are plundering Earth’s resources.

No bread? Let them eat cake! No water? Let them turn on their faucets!

Strength and Serenity for Women With Cancer

In what appears to be a perfect union between Western academic medicine and complementary/alternative treatment, a Harvard Medical School oncologist is studying the use of acupuncture to help alleviate the symptoms and side effects of cancer treatment for women. Cancer specialist and surgeon Annekathryn Goodman, MD has added acupuncture certification to her many other credentials and now offers this complementary treatment to her patients undergoing cancer treatment at the Vincent Women’s Care Division of Massachusetts General Hospital.

“My personal vision is to create a center for women with cancer that I am calling ‘Strength and Serenity,’ says Dr. Goodman. “My goal is to use complementary modalities, particularly acupuncture, to alleviate the symptoms and side effects of cancer and its treatment that we have difficulty managing with Western medicine.” She has found the treatment helpful for alleviating neuropathy—pain or burning or numbness in hands and feet, as well as nausea from chemotherapy or radiation or from the cancer itself. “Sometimes I treat women before the chemo, which seems to lessen their suffering,” she says. “Acupuncture also seems to help people who are done with their therapy but still have side effects such as fatigue, depression and anxiety as well as neuropathy. So many people are on antidepressants to help them with their stress. Acupuncture seems to help alleviate symptoms.”

Since 2004, Dr. Goodman has been transforming a sterile  Mass General exam room into a tranquil environment for hour-long sessions of acupuncture, which uses tiny needles to stimulate energy or “qi” (pronounced “chi”) points on the body, based on 5,000-year-old methods from Traditional Chinese Medicine. She uses heat lamps to warm up the needles, replaces harsh fluorescent lights with softly glowing lamps, plays soothing music and adds bamboo shoots and fabrics as decoration. “My focus is to balance the patient’s energy, or life force,” says Dr. Goodman, “This treats the ‘root’ of the problem, which then helps to alleviate the ‘branch’ symptom, whether it is constipation, nausea, headache or depression.” (Please see How Do We Heal for more details of acupuncture.)

In a recent research collaboration among the Mass General Vincent Women’s Care Division, Brigham and Women’s Hospital, and the Dana Farber Cancer Center, acupuncture was found to create a modest improvement in white blood cell counts among women undergoing treatment for ovarian cancer. (Cancer treatment tends to lower white blood cell counts, which compromises the immune system.) In a review of worldwide data about the use of acupuncture to alleviate side effects of cancer treatment, Dr. Goodman found that the evidence in support of acupuncture was “helpful but the data was mixed.” “It is hard to unify existing data in a scientific way,” she says. “But there is certainly interest around the world in studying the use of acupuncture to alleviate the suffering of cancer patients.” For her part, she hopes to continue the work of the Strength and Serenity Center to conduct education, research and clinical care not only about acupuncture, but also about other forms of complementary care for women with cancer.