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DR. STEMMLER’S MONTHLY TEACHING ROUNDS

APRIL, 2000

Clinical Story of the Month

(Copyright Stemmler 2000)

The Wound that would not Heal

Evelyn Macy was recovering from a bad year. A few months earlier her husband of 20 years had died after enduring a terrible cancer and a series of even more gruesome treatment attempts. Now Evelyn found herself alone in their big, beautiful house, which had become a hall of echoes and memories from those wonderful years spent together. She had noticed a spot on her leg for some time, but ignored it during those last months when she was totally dedicated to comfort her husband. Finally she built up the energy and courage to visit her dermatologist. A skin biopsy established the diagnosis of "squamous cell carcinoma", a common skin cancer, which is often seen in fair-skinned, sun-exposed people like Evelyn. The doctor made a wide incision and carefully removed the cancer on her anterior leg, closing the wound with surgical stitches. But the edges of the incision were pulled together at such tension that the stitches just tore, and the wound was wide open again. Since a few days had passed, the doctor did not resuture the wound, which is a prudent surgical decision, and, instead, left it open "to heal from within". Yet the gap was so wide that 2 months later little progress had been made, and skin grafting was becoming the next option. Evelyn was not sure if Chinese medicine could be of any help in her healing, but having been a patient in my practice in the past with satisfactory results for a neurological problem, she decided to consult.

When I first saw her, she was ambulating on crutches and appeared frustrated and depressed. On examination she had a deep, chronic, weeping ulcer which measured 2" in length, ¾" in width, and 1/8" in depth. I took one look at this nasty wound and told her: "I will give you 4 acupuncture treatments over a period of 2 weeks. If significant healing does not occur, I strongly recommend you consult a plastic surgeon for skin grafting." The following week, after she completed only 2 acupuncture treatments, the ulcer had closed 50%. And within 5 more treatments the lesion was almost closed. Her dermatologist was so impressed that he planned to send his father to me for treatment of chronic pain. When I saw the patient on a follow-up visit 7 weeks after her initial consult, the incision was healthy, closed and the scar almost imperceptible, an amazing result, considering the turbulent course of healing it had been through. Incisions on the leg, especially the front of the leg, have a hard time healing. Therefore, wide excisions will often require a skin graft, since the skin is taut over the bone and does not stretch as in other, more "fleshy", parts of the body.

Acupuncture increases the flow of "blood" and "Qi"; consequently, the healing process can be sped up significantly, even in situations where healing is retarded due to a large incision or a particularly slow healing bone, in the case of fractures. Incisions are usually on a "healing timer"---when the skin is cut or broken, the body’s immune and healing system sets all its mechanisms in operation. But if such a process is inhibited by a gap too large or a terrain too arid, then the body eventually "loses interest" in the injury, turns to other activities and allows the injury to fester unattended. Acupuncture stimulates the body’s own healing power and, like in this case, "wakes up the dormant power" which went into a slumber with the passage of time. Once stimulated again, Evelyn’s body responded with quick, effective healing, and the rest, well, the rest is the story you just read. Evelyn has resumed her life since her last visit. She is playing golf again, shops, goes out for luncheons and teas and, when she looks at her leg, she still cannot believe the once fearful experience that is now hiding under a tiny, little scar.

Christina Stemmler, M.D.

 

WHAT’S NEW IN MEDICINE – EAST AND WEST

WEST          (COPYRIGHT STEMMLER, 2000)

Important DRUG WARNING: Propulsid (cisapride) a "Heartburn drug".

"Serious cardiac arrhythmias…have been reported in patients taking PROPULSID." From July, 1993 through May, 1999, more than 270 cases have been spontaneously reported, including 70 fatalities."

"…PROPULSID is contraindicated in patients taking certain macrolide antibiotics (such as clarithromycin {Biaxin}, erythromycin {E.E.S., E-Mycin, Ilotycin, Pediazole}, and troleandomycin); certain antifungals (such as fluconazole {Diflucan}, itraconazole {Sporanox}, and oral ketoconazole {Nizoral}); protease inhibitors or AIDS drugs (such as indinavir {Crixivan} and ritonavir {Norvir}); phenothiazines (such as prochlorperazine {Compazine} and promethazine {Phenergan}); Class IA and Class III antiarrhythmics (such as quinidine {Quinidex, Cardioquin, Quinaglute}, procainamide {Procanbid}, and sotalol {Betapace}); tricyclic antidepressants (such as amitriptyline {Elavil}); certain antidepressants (such as nefazodone {Serzone} and maprotiline {Ludiomil}); certain antipsychotic medications (such as sertindole), as well as other agents (such as bepridil {Vascor}, sparfloxacin {Zagam}, and grapefruit juice). The preceding list is not comprehensive.

(Excerpt from "Drug Warning Letter to Doctors", Janssen Pharmaceutica, Research Foundation, January, 2000)

 

COMMENTS

There is definitely a place for drugs in our society, but society does not need to find a place for all drugs. Propulsid is what I would call "a designer drug that became too popular too quickly, among doctors and patients." It is not a necessary drug and, in fact, it is a drug most of us never needed to have been exposed to. But drugs set trends amongst us busy stressed middle-aged Americans just as the fashion industry sets trends with our teenagers. While originally intended to accelerate emptying of the stomach for patients with severe gastro-esophageal reflux, Propulsid gained fast acceptance among the overworked, insomniac, anxious and depressed men and women who eat too much or too little (but always in a hurry), drink to relax, and have a cigarette anytime they can escape a non-smoking environment. A little acid indigestion can be a wake-up call, a reminder that it may be time for a small lifestyle change. It is precisely this group of people who are on multiple medications such as antidepressants, anti-psychotics, antibiotics, anti-allergy/anti-nausea medications who succumb to fatal drug interactions. And there is also another group of people, those running on the medical wheel, patients with palpitations, high blood pressure, kidney and lung disease, for whom multiple medications are prescribed, and whose systems are weakened from both drug effects and side effects, who will be even at greater risk of succumbing to this potpourri of chemicals and suffer life-threatening conditions or die. To conclude this commentary, I would like to pose a simple question:

This drug is still on the market. Why would anybody want to take a drug, a drug for "heartburn", with so many potential side effects, requiring an EKG and blood work before it is prescribed, in addition to close monitoring during the course of treatment? The time for a return of Common Sense has come. Before taking any medication that is prescribed for you, I urge you to ask for safe, logical alternatives to treat your condition. And always ask for a drug insert, where you, yourself, can read the indications and contraindications.

Learn from this particular, yet not unique, situation. Propulsid was considered "safe", so safe that about 30 million prescriptions were written since 1993! As you can see here, numbers and mass acceptance are not a reassurance for a product’s safety. Ultimately, your health and your life are in your own hands and in how critical you are about what you allow to enter into your body.

EAST   

Cancer pain, a controllable symptom

"According to an estimate made by WHO (World Health Organization), at least 3.5 million cancer patients are suffering from cancer pain these days. Pain killing has been a hot topic in medical research in both modern medicine and TCM. From the viewpoint of TCM, pain arises when local channels are obstructed by disease processes. A time-honored method for improving Qi and Blood circulation in channels, acupuncture has proved effective in killing cancer pain. Moreover, it is convenient, inexpensive, and does not cause addiction." (Excerpt from Acupuncture for Killing Cancer Pain by Fu Wen-bin & Zhang Bo, International Journal of Clinical Acupuncture, Vol. 10, # 4, 1999.)

COMMENTS

 

The most feared symptom of any disease is PAIN and, in diseases which rarely have a cure, like cancer, PAIN & SUFFERING are part of the patient’s most feared scenario. I have often heard patients say: "I’d rather die than live in pain", and their families say: "We are devastated by his death, but we are relieved that he is no longer in pain." Pain leads to an accelerated death, yet life in pain is not worth living for most people. Cancer pain, because of its potentially worsening nature and fatal prognosis is often less endurable than chronic pain from other causes. Patients with cancer who have pain are either undermedicated or overmedicated in our hospitals, homes and hospices. With or without pain, the quality of life of a cancer patient is less than desirable. They either live in terrible and constant pain, or they are "zombies" slumped on a bed, a couch or a wheelchair. Chinese medicine can provide not only pain relief for a variety of cancer pains, but it can also alleviate fear and apprehension, which often intensify the pain. It also helps with all body functions such as appetite, sleep, urination and bowel movements, so that the body is strengthened sufficiently to better cope with pain. There are points used to open the "Qi" in the channels connecting to the organ affected by cancer (cleft points); points that, although not located on such meridians, are influential on certain organs (8 influential points); points to "tonify" the organs, to relieve "stagnation", and to eliminate "heat". Points can be used on the body and/or the microsystems of the hand, scalp or ear, for example. Timing of puncturing can be coordinated with the timing of the patient’s pain, and often semi-permanent needles can be left in for periods of time, when the pain is most intense, like during the night.

Although this article covers only the acupuncture approach to cancer pain, there are also multiple herbal preparations which can help not just with the pain, but many of the other symptoms of cancer, as well as with the immediate or long-term adverse effects of orthodox treatment modalities.

 

Christina Stemmler, M.D.


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