Alternative Medicine 1--Introduction

“Here we go again, Curmudge, tackling a topic on which the people with real knowledge of the subject fall into two camps.  Last spring it was low doses of ionizing radiation with the linear no-threshold theory vs. radiation hormesis.  Then we talked about anthropogenic global warming with the consensus vs. the contrarian perspectives.  Now you want to discuss conventional or allopathic medicine vs. alternative or complementary medicine?  So what is this alternative medicine stuff anyway?”   

“ ‘Any therapy that is typically excluded by conventional medicine, and that patients use instead of conventional medicine, is known as alternative medicine.‘  Alternative medicine includes use of natural products (herbs, vitamins, minerals, and probiotics) as well as mind and body practices (acupuncture, meditation, relaxation techniques, and movement therapies).  Julie, if you’d like a detailed discussion of herbal medicine—including history—check out Herbalism in Wikipedia.  You’ll be pleased to know that some alternative therapies are scientifically validated, although some are not.  ‘Integrative medicine combines mainstream medical therapies and alternative therapies for which there is some high-quality scientific evidence of safety and effectiveness.’ “ 

“Wow, that sounds exciting and, thankfully, reassuring.  But tell me how, Old Guy, did you get onto this alternative medicine kick, anyway?  As I recall, back on 9/23/10 we began a five-posting series on Evidence-Based Medicine.  That’s as main stream as medicine can get.”

“Right after we finished that series Mrs. Curmudgeon was diagnosed with an interstitial lung disease.  The pathologists could not agree on whether it was a treatable or terminal form.  Hoping it was treatable, prednisone—with all of its side effects including a lowered resistance to disease—was prescribed.  Then while studying the medical literature, I saw an ad for a purported alternative treatment.  I asked the doc, ‘is this snake oil?’  His reply was, ‘probably.’  At that point I decided that the alternative med might be a viable last resort.”

“I remember, Curmudge, that Mrs. Curmudgeon contracted pneumonia an top of the interstitial lung disease and died within a month.  There wasn’t time to take her to Mayo’s or implement any sort of Plan B.  In retrospect, the alternative med could not have done any less for her than the prednisone.  You were devastated.”

“And I still am.  The thought occasionally crosses my mind, ’we might have saved her.’  So that, Jaded Julie, is why we are talking about alternative medicine.”

“As I suggested earlier, Curmudge, it seems that that we have come upon another of those two-camps issues like global warming.  And members of each camp use extreme examples in describing the ‘other guy,’  The alternative medicine docs accuse the conventional or allopathic docs of being in cahoots with ‘big pharma.’  In reply, conventional physicians accuse natural medicine purveyors of being ‘quacks’ making big profits from gullible patients.  While in reality, all the patient wants is to feel better or be cured irrespective of the source of the medication.”

“Right as usual, Julie.  You and I are learning enough to give our readers a modicum of knowledge of the differences between the two main types of medicine and some guidance on where they can learn more.  That’s about all we can hope to do in a blog.”

“Before we get too deep into this stuff, Old Guy, please briefly tell me more about the differences between allopathic and alternative medicine.”

“Let’s start with allopathic.  A person with an illness goes to her primary care physician—an MD or DO—is diagnosed and given a prescription.  She takes it to a pharmacist who dispenses an FDA-approved medication.  The med is most commonly a synthetic organic compound developed by a major pharmaceutical company based on their knowledge of the cell biology and biochemical pathways impacted by the disease.  If the disease is cancer, the compound (not always synthetic) is called chemotherapy; and it’s in a race to kill or arrest the disease before the side effects of chemotherapy kill the patient.  Our series on The Ordeal  last February described the torments of chemotherapy, but it seems to have cured my friend of his non-Hodgkin’s lymphoma.”

      

“Thank God for that, Old Guy.  So if allopathic meds have FDA approval to attest to their safety and efficacy, what comparable assurance do we have for alternative meds extracted from natural products?”

“That’s one very important issue that we’ll consider in detail later, Julie.  For the moment, we can derive a little bit of confidence from the experience of ancient Greek, Chinese, Arab, and other practitioners over a thousand or more years.  If these ancient healers didn’t achieve some success, they would have become unemployed or possibly burned as witches.”

“Okay, Curmudge, why don’t the formulators of modern alternative medications do the necessary testing of safety and efficacy and obtain FDA approval?  Then their preparations would be designated conventional medicine.”

“More and more testing is being done, Julie.  However, most of the makers of alternative medicine preparations are not major corporations, and Phase I, II, and III clinical trials are very expensive to conduct.  Additionally, for a double-blind study, it may be difficult to design a placebo (sugar pill) that looks exactly like an herbal concoction.  Perhaps the best route for a little guy with a potential blockbuster drug is to be acquired by a major pharmaceutical company.  Of courser, some purveyors of alternative meds are already making sufficient profit that they might consider conducting trials and seeking FDA approval to be not worth the trouble.  And finally, some others feel that if an alternate therapy is not based on a plausible scientific mechanism, a clinical trial is not appropriate.  After all of that, use of an approved ‘miracle drug’ is never a sure cure for an individual patient anyway.”

“I have an idea, Professor.   We’ve talked a lot today, and it’s time for a cool one (glass of water).  Perhaps we should assign Wikipedia’s excellent introduction to Herbalism as a homework assignment for our readers.  Then we’ll move on to searchable databases in our next session.  Also, you neglected to mention the Mayo Clinic’s comprehensive and authoritative Book of Alternative Medicine. (1) ”

“Jaded Julie, what would I do without you?”

Kaizen Curmudgeon

(1) Mayo Clinic Book of Alternative Medicine, 2d ed. (2010, Mayo Foundation for Medical Education and Research)

Link to posting from blog archives: Patient Safety—Medications 1/08/09

http://kaizencurmudgeon.blogspot.com/2009/01/patient-safety-medications.html

Companion Qualities

“You know, Julie, the other evening as I sat alone dreaming of days gone by…”

“Sure, Curmudge, and smoke rings would have been swirling around your head except for the fact that you never smoked.”

“I dreamed of the girl that I used to know…”

“That would have been the late Mrs. Curmudgeon.”

“Right, Julie.  I was thinking of the qualities that she had that are no longer a part of my life.”

“And because I can read your mind, Old Geezer, I know that those are the very same qualities that one seeking a mate should be looking for.  That’s why we’re sharing this—for other people—most certainly not you.”

“Most certainly.  So here’s the list; they may bring back fond memories to many of my senior citizen neighbors:

Companion Qualities: The Non-Procreative Aspects of Having a Spouse

or ‘Significant Other’

Regular, but not constant, companion.  Always accessible when needed.

Emotional companion.  Sharing the beauties of travels, music, etc.  Sharing the joys and sorrows of health.  Sharing successes and failures.

Consultant on most everything in life.  Living location and space.  Food.  Clothing.  Interactions with people, from children* to business.  Making decisions. 

Honest, constructive critic on everything from behavior to quality of work.

Doer of things for one that can’t be done alone.  Example: Changing a bandage in the middle of one’s back.  Driving one home after a colonoscopy.

Provider of support, emotional and physical (e.g., putting up a picture).

Participant in the duties of a household.**  Meal preparation.  Shopping.  Putting out the trash.  Maintaining a mutually acceptable level of neatness.

Financial companion.  Assist in setting goals, paying debts, and sharing of financial responsibilities.

Communicator.  Keeping lines of communication open and life on an even keel.  Meeting appointments and obligations.

Amateur diagnostician.  Being ‘Doctor Mom.’

Forgiver for most indiscretions.

Maintainer of own individuality.

Mind-reader and flexible negotiator.

Capable of developing common interests if they don’t already exist.

Able to resolve or accommodate differences in religion & politics, if they exist.

_____

Notes:

*We assume that children, if any, are grown.

**Only meaningful if a physical household exists.     

For anyone using these notes in selecting a mate and who has achieved a modicum of success up to now, a prenuptial agreement is mandatory.”

“That’s a petty good list, Curmudge.”

“Maybe, Jaded Julie, you should sit down with your laid-back husband and discuss how well the list fits the two of you.  Of course, don’t try that when there’s a football game on TV.”

Kaizen Curmudgeon

Link to posting from blog archives: Patient Safety—Falls 2/12/09

http://kaizencurmudgeon.blogspot.com/2009/02/patient-safety-falls.html

Mourning—Almost Three Years Later: Absence

 “Curmudge, you are definitely in a black mood today.  Please explain.”

“Although we didn’t name the series of postings at the time, Julie, today’s discussion is the fifth installment of our series on Dying, Death, Grieving, and Mourning.  The first two, Way to Go and Way to Go 2 were posted right after Mrs. Curmudgeon’s death, and the third, The Old Men’s Table, was posted three months later.  The fourth, The Almost-Invisible Emotion, was written two years ago but not posted until last week.  So this week’s posting, Absence, should be the fifth and—hopefully—the last.  Unlike most of our discussions, these sessions are not fun, but they are good therapy.”

“Shall we start with the question that most people ask you, ‘How are you doing?’”

“And my usual reply is ’not bad’ or ‘okay.’  And then I add ‘there’s no such thing as good.’  I suspect that no widow or widower truly feels that they are living ‘the good life.’  However, each person may have his or her reason for feeling that way.  There might be people out there who jump for joy, but I don’t see any of them where I live.  In fact, most of my neighbors probably can’t jump for any reason.”

“Last week (actually two years ago), Curmudge, we ended with your planning to celebrate the joys that you and Mrs. Curmudgeon shared together.  How did that work out?”

“Not bad, Julie.  It was a pleasure to recall the things we did on our trips to Europe, but I never want to go back, especially alone.”

“Why not?”

“It would never be the same.  A castle would just be a pile of stone, not an experience.  It’s one of those things that one can’t appreciate until you have been there with someone you love.”

“Wow, Curmudge!  I wonder if I can talk my couch potato husband into taking a trip to Europe.  So what about those years when your job required you to live in the Northwest for a month at a time?”

“It was not the good life, Julie, but I felt her presence from 2,000 miles way.  I always knew the number of days and hours until I could return to Wisconsin.  And I could enjoy the views of the Columbia Gorge for her because I knew I would share them with her on her next visit to the West.”

“I’m sure that you appreciated being transferred back home, Old Guy.”

“To say the least.  Then I could sense her presence when she was a mile away at work, playing the piano in the living room, or reading a book upstairs.  It must be something that develops in the deep recesses of one’s mind during 50 years of marriage.”

“And finally, as the doc pronounced in the ICU, ‘she’s gone.’ “

“Right as usual, Julie.  Yet my sense of her presence did not die with her.  During the subsequent year that I lived in our house, she was everywhere.  Almost everything in the house was in some way hers, and I sensed her presence—almost as a ghost—everywhere.  So I sold the house, complete with a ghost who wasn’t in the contract.”

“I certainly hope the new owners don’t hear someone playing the piano in the middle of the night.  Well, Curmudge, how is it now that you live in an apartment in the old folks home?”

“Once again, Young Lady, I must remind you that it’s not an old folks home.  The apartment is quite adequate, very quiet, and I get lots of writing done.  There is no ghost in residence, but I sense Mrs. Curmudgeon’s absence.  The presence feeling in the back of my mind has been replaced by an abject emptiness occupied only by memories.  And it may be here to stay.”

“But you attend shows and other events with your friends.  Don’t they help?”

“They are wonderful therapy and they drive mourning right up into the theater’s fly space for the whole day.  But when I get home, absence is waiting.  It’s no big deal; it may be living in most of the other apartments in my building.”

“We both know, Old Guy, that our discussions usually end with a lesson.  What is it for today?”

“It should be obvious, Julie.  Death is a part of life.  We can accept it as inevitable, but that doesn’t mean that we have to get comfortable with it.”

Kaizen Curmudgeon

Link to posting from blog archives: Patient Safety—Infections 2 2/05/09

http://kaizencurmudgeon.blogspot.com/2009/02/patient-safety-infections-2.html

The Almost-Invisible Emotion

(Written August 11, 2011 but not posted.  At that time it was considered too personal to be in a corporate blog.)

“Curmudge, it’s been eight months since the passing of Mrs. Curmudgeon.  How are you doing?”

“Everyone asks that, Jaded Julie, but the widows and widowers already know the answer.  They can see the occasional vacant stare in my eyes because they’ve been where I am.  Some are still there.”

“So once again, how are you doing?”

“My standard answer is, ‘fine outside, but not fine inside.’  What goes on outside is called ‘mourning,’ and as you see, I’m not wearing sackcloth and ashes.  The inside goings-on are called grieving, and I’ve gone through several of its well-known stages.  The survivor is typically in shock for the first few weeks; that period covers the memorial service, and the start of paperwork like paying the funeral home, sending death certificates to life insurance companies, and collecting your $255 from Social Security.  Then come several months of denial, when you keep thinking, ‘I can’t believe she’s gone.’ “

“During the ‘shock’ period in February was when I played the part of your dying wife in our two postings, Way to Go and Way to Go 2.  That was a tough role, but I considered it an honor.  Hopefully our readers learned that there are some instances when a partial code is desirable.  Later, in The Old Men’s Table, you spoke for other widowers in declaring that thoughts of your own demise had lost their sting.  Do you still feel that way?”

“Actually, I hadn’t thought much about it, but it’s probably true.  And now I’ve moved on to the next phase of grieving, in which I have to learn to adapt to the reality of my wife’s passing.  This could go on for several more months, or years, or forever.  It’s not a matter of learning how to live by myself; I did that for seven years when I worked in the Northwest.  The difficulty is learning to live with myself.  I simply have to adjust my mind to her permanent absence.  I have problems doing things alone that we used to do together, like traveling or going to the opera.  In fact, I find it depressing to even think about doing them.”

“I understand that you have a close college friend—as old as you are—who remarried within a year of his wife’s passing.  That probably cured his grieving in a hurry.”

“I wish him well, but that‘s not something that my brain—or maybe even the rest of me—could handle.”

“Curmudge, we wouldn’t have talked this long without your having at least the kernel of an idea of how you are going to extricate yourself from this mess called grieving.  Now’s the time!”

“For me, the most important thing all along was to keep busy.  As you know, I returned to my volunteer job two days after the memorial service.  Perhaps now I should return to other activities that I used to enjoy—like singing in the church choir—as if I had never left them.”

“Sounds good to me, Curmudge.  But your biggest challenge will remain reprogramming your mind to accommodate your life’s new reality.  So how are you going to pull that off?” 

“A few weeks ago I was congratulating a 90-year-old woman on her independence and ability to drive her own car to church.  She mentioned that she knew how I felt about losing my wife, because she felt the same way about losing her husband of 60+ years who had also died recently.  She also said that she felt blessed by her long life, her independence, and her long and happy marriage.”

“I’ve got it Curmudge!  She was counting her blessings, not her losses.  I’ll bet she looks back on her many years of marriage as joys and not as things to be mourned.  You should do that too.  See…one does gain wisdom with aging.  Perhaps you’ll acquire some by the time you reach 90.”

“As usual, Jaded Julie, yours is a good idea.  I’ll give it a try.”

Kaizen Curmudgeon

Link to posting from blog archives: Patient Safety—Infections 1/29/09

http://kaizencurmudgeon.blogspot.com/2009/01/patient-safety-infections.html