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DR. STEMMLER’S MONTHLY TEACHING ROUNDS

JULY, 1998

CLINICAL STORY OF THE MONTH

(Copyright Stemmler, 1998)

It rarely rains in Tucson, Arizona. Eight to twelve inches a year perhaps, while in Houston the same volume can pour down in a single afternoon!

Yet that Friday afternoon it was raining real hard in Tucson, that kind of short, intense summer splash known in the desert as a monsoon. It comes without notice and stops just as sudden, leaving behind two and often three rainbows, and an army of happy, swollen, revived Saguaro cacti, the ancient sentinels of the Catalina mountains.

It was on such a Friday afternoon about a year ago, when I met W.S., a 58 year old engineer during one of my lectures and book signing at a major book store in Tucson. He was sitting in the first row and appeared to be intensely immersed in my presentation. Once the lecture concluded, he rose with some difficulty, and with the aid of a cane and a noticeable limp, he slowly approached the podium.

"Do you think you can help me?", he asked with guarded hesitation. "I have a rare form of arthritis in my hips and I have become progressively disabled".

The next week, at his scheduled appointment, he told me his story. Two years earlier he had begun experiencing pain and stiffness in both hips. His "PCP", or primary care physician, as family doctors are now being referred to within the managed care systems, prescribed antiinflammatories, muscle relaxants and pain killers for nearly a year, repeatedly refusing his request to be referred to an arthritis specialist. In spite of the fact that he was becoming progressively disabled and eventually had to use a cane to walk without falling.

 

So finally W.S. decided to see a rheumatologist "out of pocket", and he even traveled out of state to obtain the needed care. The specialist diagnosed his condition and instituted a strict treatment regimen with powerful drugs, including steroids. Even though the symptoms improved, he still had significant pain and was dependent on his cane for ambulation. During the course of his disease and treatment, W.S. also developed a number of adverse drug affects, the onset of diabetes, indigestion and stomach pain, as well as severe anxiety.

After I evaluated him, I began treating him immediately with acupuncture and Chinese herbs and, within two acupuncture treatments, he forgot his cane at home and has never brought it back since. With regular acupuncture treatments his pain was controlled, the mobility of his hips improved significantly, and he was able to live a normal and active life.

And so it would seem as if this was the happy ending of the story, Chinese medicine saving him from succumbing to a wheelchair and total disability.

But the story does not end here. One day, a couple of months ago, W.S. came for his scheduled visit and just on passing mentioned that he had been experiencing a lot of stomach pain and indigestion. Especially after meals, and when moving or walking around after eating. Of course I did not ask W.S. to get ready for his acupuncture treatment; instead I listened to his heart and lungs and ordered an EKG. During further questioning I learned that W.S’s. last "indigestion" bout had occurred when walking up from the parking lot to my office. His EKG indicated that his heart muscle was "hungry" for oxygen, and such findings were definitely different from an EKG done six months earlier. I called my consulting cardiologist and told him that I suspected that my patient was having a heart attack and asked him to admit him to the ICU and possibly perform a heart catheterization on him.

W.S. was in strong denial. Fear had frozen his common sense. "No, I’m not going to the hospital. I have appointments in the office in the morning". And "My wife is out of town" and even "My car-I can’t just leave it here". When it comes to life and death situations, I usually resort to a less conventional but more effective way of counseling. W.S.’s dad and brother had died suddenly at his exact age and he had so far survived them for just a few months. After saying a few things that helped him defrost his thinking, I summarized it all through a simple message: "W., it is my job to help you outlive your kin".

Within less than ten minutes, we had a driver assigned to his car, the nurse following right behind them, and W.S. being transported to a nearby emergency room-cardiologist on alert and team ready to go. On catheterization all the important arteries in his heart were practically closed and his heart muscle was weak and damaged by his recent as well as older, silent heart attacks.

A week later, W.S. was discharged on various medications to protect his injured heart and drain the fluid from his lungs and ankles. W.S. was very excited about surviving his heart attack after nearly committing suicide by denial, a common cause of death in men who do not want to have a heart attack, and just ignore their symptoms or write them off as "indigestion". The first hour or two after a heart attack are crucial for survival. Had this patient been treated with acupuncture, herbs, antacids, reassurance or other non-urgent modalities, he may not have survived the evening.

So now you may think that this is the happy ending, and that Western medicine saved W.S. from a sure death. But the story goes on.

W.S. really needed a triple bypass, but the cardiologist was very concerned about his surgical risk. Having diabetes and a very debilitated heart, put W.S. in a 10% very high risk group with a fairly low chance of surviving the surgery at all. He was therefore sent to the best cardiovascular surgeon in town, who was known for only taking high risk patients. Even the surgeon was rather pessimistic about W.S.’s chances to survive the surgical procedure in the first place, and to later pull through the many post-surgical complications he predicted in his case.

So here we are finally approaching the end of this story.

W.S. did decide to take the risk of undergoing surgery. The alternative of experiencing a heart attack and sudden death like the other men in his family within a year was not an acceptable option. A few days before his surgery I scheduled him for two acupuncture treatments to "open all his channels" and to " strengthen his Qi(chee)". With that approach I intended to give him the best chances for enduring the stress of surgery, and handling any possible complications. After all, Chinese military men historically used to acupuncture their horses before battle, in order to improve their performance and athletes often seek acupuncture treatments before their competitions. W.S. was about to face the toughest battle of his life.

And this is truly the happy ending. Not only did W.S. do well during and after surgery, but he also beat all the odds he had against him. His heart responded so well that it did not even need to be stimulated before coming off the pump.

The next morning, while W.S. was having breakfast comfortably sitting up in bed, the surgeon came by on his daily rounds. He was rejoiced: " You have moved from the lower 10% to the upper 90% uncomplicated group - unbelievable!".

The cardiologist, equally marveled, suggested on a recent telephone conversation we had: "Perhaps we should send you all our high risk patients!".

W.S. and his wife are starting a new life together. His heart is performing well, he has hope, and he will most likely survive his kin by several years.

And yes, we have come to the end of this special story, one that so clearly demonstrates the value of integrating Eastern and Western medicine for us all.

 

Christina Stemmler MD


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