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DR. STEMMLER’S MONTHLY TEACHING ROUNDS

AUGUST, 2001

(Copyright Stemmler 2001)

"I’VE SEEN SEVENTEEN DOCTORS— YOU’RE NUMBER EIGHTEEN"

This is what Paco Shores, a seventy-year old retired businessman told me while we were shaking hands on our first encounter that late summer afternoon.

"Here, Doctor, this is my list of medications, all the doctors I have seen, and all that was done to me. Still no diagnosis, nobody knows why I am hurting so badly here," he continued, as he pointed to his right lower abdomen and genital area. I glanced over the sheets, neatly typed on an old Smith-Corona (new ribbon, I could tell.) Many of my older patients refuse to even get close to a computer. Yet, most of the tests he had undergone were computerized—the paradoxical relationship between man and the machines that run our lives.

He was standing. I pointed to the armchair as I was ready to sit down on my stool.

"No, thank you," he responded. "Sitting makes the pain unbearable." And then he told me his story.

The patient had endured and survived several major illnesses: severe cardiovascular disease with a heart attack in 1987 followed by several angioplasties over a 7-year period, a bleeding ulcer, knee surgery, an appendectomy, asthma and chronic cough, sinus allergies, high blood pressure, and elevated lipids. Genetically, he was predisposed to live a short life. His father died suddenly at age 62 and his brother at age 59—both from heart attacks. Advancements in cardiovascular surgery had bought him another decade, but this pain interfered with his ability to enjoy life. Paco Shores and his wife loved to travel; the money was there, but sitting on an airplane—even in first class—was out of the question.

"Can you help me, Doctor? You’re my last hope!"

"Yes, I am pretty sure I can," I said after examining him and reviewing his extensive workup. When you see 17 doctors, you can expect at least as many tests being ordered, and many more.

He had recently undergone several CT’s, MRI’s, a colonoscopy, a barium enema, ultrasounds, and an angiogram. No diagnosis was ever formulated. Multiple treatments were attempted without a diagnosis, and, of course, none of such aimless interventions worked. In addition, he was taking 2 blood pressure medications, a pill for acid indigestion, one to lower his cholesterol, one to help him with his esophogeal reflux, and like many men his age, Viagra had a place on his nightstand. He had actually become impotent from the additive adverse effects of his medications. On his own, Mr. Shores had also gathered a number of vitamins, desperately hoping to derive benefit from a nutritional approach.

"Now they want me to go to surgery. My gastroenterologist is very insistent on it. I’ve seen 3 surgeons so far, and all 3 have told me that there wasn’t anything they could operate on. All tests are negative. But my gastroenterologist says "there must be something there with all that pain, we need to explore.’ What do you think, Doctor?"

"Well, I think it is a desperate move to fumble around inside your abdomen, trying to find a visible explanation for an invisible problem—that of a dysfunction."

A physiological malfunction, if it does not manifest as a structural abnormality, cannot be seen on X-rays, endoscopies, CT’s, or MRI’s. And it will most likely not be seen with the naked surgeon’s eye either. It is like hunting a ghost that has no shape or form. Functional disorders are the "ghosts" of Western medicine, but they are old familiar friends to a Chinese medicine doctor. When we talk about Qi or about Yin and Yang, we may seem, to a Western medicine doctor, to be talking about ghosts or just silly nonscientific concepts.

"Your pain comes from a functional disarray that probably originated from your inguinal and lower abdominal region after catheterization and a surgical procedure. You have a big scar there from your old complicated appendectomy in 1947. We human beings are resilient creatures, but our general condition and associated diseases will make us less or more susceptible to dysfunctional states; more or less tolerant to invasive procedures that are performed time after time. Remember, you had several catheterizations, and maybe that last one was all it took to spill over."

"So what shall we do now, Doctor?"

"Well, now we are going to draw from some pretty sophisticated techniques developed by brilliant doctors in ancient China."

I knew I had to use a variety of systems. His pain was severe, his condition "deep," and his hopes high. I started with one of the 8 extraordinary or curious meridians, which treat more complex and deeper-seated dysfunctions. In addition, I used points from various microsystems: foot, nose, ear, and both Chinese and Korean hand points. Initially, I planned to treat him 3 times a week, and extend his treatment intervals as he improved.

He felt better after the first treatment, noticing a reduction in his inguinal pain. By the third visit, he had no more tenderness on palpation, but the pain above his penis had increased. This was a delicate moment; the patient had never been blessed with patience. I often wonder why people who come to the doctor are even called "patients." And an increase of pain anywhere, especially close to his manhood, was just unacceptable to him, but we managed to survive that visit with some coaching and lots of humor. The next visit, he reported waking up without pain for the first time in 1 year.

On his sixth office visit, Mr. Shores reported a full pain-free day after his treatment. He said, "Doctor, if you can cure me, I’ll give you a kiss!"

I smiled. He was not the effusive type. It was just that out-of-character spontaneity that made his promise that much more powerful. Of course, while I was treating his pain, he also requested "additional points," as most patients do, for his sinuses and for his sexual potency. He continued to improve, and by the tenth visit, he went on a vacation for 2 weeks.

On returning, he reported that the lower abdominal pain had completely resolved, but the inguinal pain was still there to some degree. It was time to use a different curious meridian, which was better suited to resolve the remaining pain.

By the fourteenth visit, he was 95% improved, but by the fifteenth visit—Oh, no! The pain returned. I really had to pick him up this time; his hopes had fallen so low. I knew it was probably one of the last "sparks" of "blocked Qi." Soon, Qi would flow normally again, and his pain would disappear completely. So, I was not at all surprised when, at his next visit, he informed me that he had no pain the day of the treatment, some pain the next 2 days, really bad pain on the third day, and significant improvement since.

On his seventeenth and last visit, he was 98% improved, and had only slight pain left at one precise point on his side, which corresponded to a very important meridian point. I treated this point on his body and the corresponding point on his right hand. I never heard from him again, until 1 year later.

He came trotting in, rejuvenated and obviously quite happy. He walked towards me, his wife chuckling. "Time for that kiss," he said, keeping his promise. He had been pain free for the entire year since his last visit.

"Thanks for letting me know," I fussed. A brief phone call, a fax, an email, a post card, just to let me know "No pain, Doc! Just having fun!" would have been appreciated. Too often, patients get well and tell everybody, except the doctor. They don’t return, and leave without saying goodbye. We, doctors, are people, too!

Why was he here this time, I wondered.

"Well, Doctor, you did so good the first time. So how about treating all the other things now? I am having lots of problems with my sinuses. I also have this chronic cough, reflux, hypertension, high cholesterol, and you know what. What we discussed last year."

"Ah, Doctor, and you’d love to hear this one. About 5-6 months after I saw you, I went to see my gastroenterologist. He wouldn’t refill my medications unless I saw him. So, I went. And I told him that I was cured, that I had seen a doctor acupuncturist, and that all my pain was gone. Hadn’t had any pain in half a year. And do you know what he said? He said, ‘You still need an operation, an exploratory laparoscopy. We need to find out why you were having pain before.’ I said, ‘But doctor, I have been free of pain for almost 6 months!’ He insisted, ‘You still need an operation!’ How weird is that? Even though 3 surgeons had already told me "no surgery," long before I came to see you?"

Set in his ways, all right, I thought to myself as I took my first needle out of the sterile package. The patient smiled. "There you go again, Doctor. You really like to hurt me, eh?" We laughed. It was good to see this man enjoying life again—traveling all over Europe, booking cruises, playing golf.

Western medicine had given him a ticket to life; Chinese medicine had provided the royal accommodations. It is not just about life, what we doctors must do for patients, but more importantly, it is about quality and enjoyment of life.

Lessons Mr. Shores Taught Us

Patients have been my best teachers over the years. They have taught me to be patient even though, usually, they are not. And they have taught me to persevere, to not give up, and to understand small setbacks as part of the waxing and waning of the healing wave in progress. They have taught me to listen to my patients’ stories rather than join the majority voice of my colleagues’ opinions.

And thanks to lessons like Mr. Shores’, I stand firm and grounded, evaluating each clinical situation without the bias of previous failures, also teaching my patients to join me in achieving their recovery.

Christina Stemmler, M.D.


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