Peripheral Neuropathy and Integrated Medicine
We have already discussed some of the causes and conventional treatments for peripheral neuropathy.
Unfortunately many people are not much helped, and it is good to know what else may assist them. And also what may not: sadly people suffering from chronic illnesses often become the victims of people selling treatments that may have scant chance of success.
There is not much research to support most of these approaches, which we use in tandem with conventional medicine. However, I’ve used all of these approaches and found that each has helped some people. The problem, as with most of conventional medicine, is in knowing who will respond to what. Often the key is to use several approaches in combination. That is where you need a specialist in Integrated Medicine who can put together the right “package” of treatment for the individual. What we don’t want to do is use a kind of “blunderbuss approach,” where we hit people with everything at once.
- Diet and exercise may help, particularly in diabetic neuropathy, where improved metabolic control will reduce – but not abolish – the risk of neuropathy, and may improve pre-existing neuropathic pain.
- Some naturopaths in Europe recommend using parsley, celery and carrot juices. Not something that I’ve seen work, but some people tell me that they’ve found them helpful.
- There has been a lot of research on the use of alpha lipoic acid and vitamins B and E, particularly in diabetic neuropathy: some positive and some negative. Each has sometimes helped in clinical practice, though you have to be a little careful with vitamin E: it can impair the clotting system, and cause diarrhea and transient elevations in blood pressure.
- Acupuncture – traditional Chinese, “Western Medical,” and electro-acupuncture – have been used a lot in peripheral neuropathy. There have been some positive studies in painful diabetic, HIV-associated and chemotherapy-induced neuropathy. None of the studies has been perfect, but they tend to support the clinical impression that man people are helped – some greatly – but few are cured with acupuncture. There have also been negative studies. There are also some positive studies from China, but only a few have been translated in their entirety. There are often two big problems with research done in China: many Chinese investigators feel that it’s unethical to include a control group, and their studies tend to use endpoints like “cured” or “partially cured,” rather than objective rating scales. I have used it in peripheral neuropathy, but it’s extremely important to use scrupulous technique, since people with neuropathy are at increased risk of getting skin breakdown and ulcers, especially if they also have any vascular compromise. Many of us have also found that it can be helpful in compression neuropathies, like carpal tunnel syndrome. There’s recently been some fascinating research using brain imaging in acupuncture treated carpal tunnel syndrome.
- Herbal remedies are used by about a fifth of people with neuropathy, but I’ve never had much luck with them. Some herbalists tell me that they have good results with an array of different herbs, though there is little objective evidence that they work.
- There have been clinical reports and at least one research study on the use of magnet therapy in neuropathy. Earlier this year there was an article in the British Medical Journal that was critical about magnet therapy in general. The article provoked one of the most vigorous debates that I’ve seen in along time. I’ve not seen it help, but there are some people who swear by it. And other who swear at it!
- There have been many attempts to use electrical fields to help neuropathy, from the conventional transcutaneous electrical nerve stimulation (TENS) boxes, to yet more variations on electro-acupuncture. Some people are helped, and these are good extra tools.
- Many homeopathic remedies have been used in neuropathy. Homeopathy is a highly individualized form of therapy: no two patients will get the same remedies. But some of the most commonly used remedies are Agaricus, Alumina, Arsenicum album, Natrum muriaticum, Phosphorus and Plumbum. If you live somewhere that there are good homeopaths, homeopathy is an option to consider, despite the dearth of good research into its use in neuropathy.
- It is important not to neglect the psychological aspects of neuropathy: people can become profoundly depressed by the intractable pain, and sometimes psychotherapy and antidepressants can be a helpful.
- Finally, ask yourself what the neuropathy is trying to teach you. There is no problem that comes out of a clear blue sky, and it is always valuable to look beyond the physical problem itself to its meaning and purpose.
If you are not having success from conventional medicine alone, or if you don’t care for conventional medicine, then discuss these options with a professional, use your intuition to guide you, and let us know if you have success.
Restless Legs Syndrome and Integrated Medicine
In the last entry we looked at RLS: what it is, and some of the conventional approaches to treating it. I now want to spend a moment talking about some of the other approaches that we have tried. For most of these there is very little evidence, so we use them in conjunction with conventional medicine.
If you want to try any of them, discuss them with your health care provider, so that he or she can guide you toward the best ways of putting treatments together.
- Diet: A low sugar diet helps some people, and it is always worth keeping a food diary for a week to see if there’s any association between something that you’ve eaten and a worsening of your symptoms.
- If you like juicing, there have been a number of anecdotal reports of the use of carrot, celery and spinach juices helping some people. (I am writing this while we are still in the middle of the spinach/E. coli scare, so leave this one out until the FDA has given us the all clear.
- There have been publications about the use of vitamins E and B and folic acid in RLS. Vitamin E can cause a GI upset in some people and if used in too high a dose (above 800IU/day) may elevate blood pressure; folic acid has to be used with caution in people on anticonvulsants. If you try these options, bear in mind that no supplement is likely to work unless it is taken for at least a month.
- Acupuncture sometimes helps: there are three acupuncture points in the legs that come up in the prescription: Urinary bladder 57, Spleen 6 and Stomach 36.
- Homeopathic remedies have been reported to help, and I’ve had some success. The precise remedy always depends on the precise characteristics of the individual, but the most common ones have been Rhus Toxicodendron, Causticum, Tarentula Hispanica and Zincum Metallicum. If you live in a place in which there are good homeopaths available for consultation, it’s another option.
- Several herbal remedies have been reported to help: Passion Flower, Cimicifuga, Valerian, Black Cohosh and Piper Methysticum. Just remember that some of the herbs sold in health food stores don’t contain what they should, and Valerian and Black Cohosh have recently been associated with liver toxicity in some people.
- Here is an old trick from China: take a one inch piece of fresh ginger root and grate it into a bowl of warm water. Then soak your feet in the water for about ten minutes. I’ve never seen that one work myself, by some people whom I respect have.
I also think it important not to neglect the psychological aspects of this problem, and sometimes some psychotherapy can be a helpful adjunct.
Finally, ask yourself what the RLS is trying to teach you.
These are all options that have been tried and have helped some people. If you are not having success from conventional medicine alone, or if you don’t care for conventional medicine, then discuss these options with a professional, use your intuition, and let us know if you have success.
The Ethics of Complementary, Alternative and Integrated Medicine
In my recent item about ethics I mentioned that Paul Root Wolpe from the University of Pennsylvania is interested in the ethics of Complementary and Alternative Medicine (CAM), and, by extension, its offspring, Integrated Medicine. This caused some raised eyebrows, but it shouldn’t.
Using unorthodox therapies carries a number of ethical and moral responsibilities.
When I was still on faculty at the University of Pennsylvania, on one occasion I caused outrage amongst many friends using natural medicine, when I pointed out on a TV show that just because something’s natural doesn’t mean it’s safe. Think arsenic, deadly nightshade and hurricanes! But there is more to the ethics of CAM than just the safety of the treatments involved.
Just a few months ago I was asked to look at a study by someone claiming to debunk one of the tapping therapies. Neither the investigator nor the practitioners and patients inveigled into the “research,” understood the principles of informed consent. This is important: one of the many consequences of the Holocaust was a re-consideration of what to do with medical “data” collected by Nazi doctors in the most unprincipled ways imaginable. Should the data be kept, so that people would not have died in vain? Or should it be destroyed, because information from unethical experiments was tainted. After a great deal of heart searching, it was decided that any information obtained under those circumstances was likely to be junk. This is one of the reasons for the absolute insistence on informed consent. I shall say something else about consent in just a moment.
Let’s have a look at the ethical issues involved in CAM, because much of the criticism of the emerging models of healthcare has come from people genuinely concerned about patient welfare.
- If we do anything with or for an individual, there has to be informed consent. Informed consent includes full disclosure not just of the chances of efficacy, but also of the possible toxicity of a treatment and an agreement of what we hope to achieve. A therapist may want to balance your Qi and stop you getting sick in the future. You may just want to be rid of your headaches. When we ask about the chances of efficacy, we all run into the problem of positive bias. I was once planning some research with a very well known practitioner in the UK, who told me that he cured every single person he saw, whether they had cancer, schizophrenia, heart disease or anything else. I was astonished, and asked him for something to backup what he said. He flew into a rage! “How dare I question him?” he said.It soon turned out that although he probably was a genuine healer who got a lot of people better, he had no evidence at all. It was like a study in the medical arena in which the investigators decided that anyone who did not come back for treatment was cured! Not a common reaction if someone fails to turn up for an appointment!
- People often say to me that there can be no harm in giving someone a homeopathic remedy. And of course, from a purely physical and psychological perspective, that’s probably true. Though I once participated in an experiment in which I took the homeopathic remedy Pulsatilla, that is prepared from the Passion Flower. I had what is known as an exacerbation, and was unable to function for several hours. But we also need to think about some of the other things that can follow from using treatments that work at the level of the subtle systems. One of our biggest objections to people who believe that they can do acupuncture after a weekend course, is that acupuncture, homeopathy and the rest are powerful medicines. Putting a needle into the wrong part of a person’s anatomy may not just cause physical harm, but can do extraordinary things to a person’s subtle systems. A fact that is exploited in some martial arts. In the Jet Li movie Kiss of the Dragon, Jet uses acupuncture needles to do some extraordinary things. The filmmakers used little artistic license: with one exception I have personally seen all of the things demonstrated in the movie.
- I mentioned that informed consent includes full disclosure about the chances of efficacy and toxicity of a treatment and agreement on therapeutic goals. We can find ourselves in a real ethical dilemma when patients have unrealistic expectations for an untested remedy. Sometimes people don’t inform their patients realistically, and they rationalize it as either choosing not to remove hope or as providing support. But we have to be sure that we are not supporting potentially dangerous or harmful decisions. The problem is not necessarily the treatment itself. Using an untested treatment in place of something that we know can be effective can also lead us into difficult ethical waters. Regular readers will remember a sad case that I highlighted a few months ago.
I’m all for holistic therapy: the less invasive the better. I’ve spent the last 35 years helping develop new and better ways of integrating treatments.
But it’s really important to be realistic, to use what we know works and if we don’t know if a thing works, then to be totally honest with the individual, and keep meticulous records of why we want to use an untested remedy in combination with the conventional.
In the 1980s, the Research Council for Complementary Medicine began to train complementary practitioners in the basics of research, so that they could be better at obtaining informed consent and monitoring the effectiveness of treatments that they were using. We had some success, and it is high time that we helped practitioners in other parts of the world do the same thing.
Arnica Montana and Bruising
One of the best known homeopathic remedies is Arnica montana. Also known as Leopard’s Bane, mountain tobacco and sneezewort, it is found mainly in the mountains of Europe and in Siberia. The homeopathic remedy is made from the dried roots or sometimes the dried flowers of the plant.
It is the classical remedy for bruising, though homeopaths also use it in many other conditions. It was one of the first remedies that I ever learned about. In England we play a lot of rugby football, a game that can get rough. Most rugby clubs keep homeopathic Arnica in the dressing room, and it has always been said that it reduces the number of bruises after the game.
Yesterday, in the early afternoon, a ladder fell on my ankle: one of the perils of doing farm work. It was a very large heavy object and the injury bad enough that everyone wanted to cart me off to the ER for X-Rays. A swelling the size of half a grapefruit would tell most normal people that an X-Ray would be a good plan. But I decided to stick with Arnica and elevation of the offending article.
And as I was trying to limp around, I lamented the fact that I have only two legs and not four.
This morning – less than 18 hours later – the swelling has gone and there’s no bruising.
So that’s an "N of One" study.
Is there any decent research on Arnica?
One study claimed to find no benefit, but if you click on the link, you will see that there was some spirited argument about the experimental design.
Two other pieces of research have looked at the effects of using Arnica around the time of operation. One examined people having surgery for carpal tunnel syndrome, and reported benefit. Another looked at the use of Arnica in people having face lifts, and again reported less bruising.
A study from Israel indicated that it might reduce bleeding after childbirth.
It did not help muscle soreness after long distance running.
A study from Switzerland suggested that an Arnica-containing gel might help with the pain of mild to moderate osteoartritis of the knees. This wsa not a homeopathic preparation, but a herbal one, and occasionally contact dermatitis can occur if the herb is used. It’s uncommon, but worth knowing about. I’ve not heard of contact dermatitis occuring with homeopathic remedies.
I’ve always been most impressed by sudies of the use of homeopathy in animals, where the placebo effect is small. And we have seen excellent results in dogs, cats, horses and fish. There’s a study from India re-examining the treatment of bovine mastitis, and claiming that Arnica is one of a number of helpful remedies.
Arnica has also been shown to reduce swelling in a rat model.
The conclusion from all this?
Apart from my experience today, the balance of evidence suggests that Arnica can help prevent bruising. It may have many other uses in the hands of an experienced homeopath.
I always keep some handy and use it as an adjunctive treatment to more conventional approaches.
Cycles
“Human beings, vegetables or cosmic dust, we all dance to the same mysterious tune, intoned in the distance by an invisible player.”
–Albert Einstein (German-born American Physicist and, in 1921, Winner of the Nobel Prize in Physics, 1879-1955)
My next full-length book will be entitled Sacred Cycles. I am in no doubt that an essential key to healing, and to finding and following the meaning and purpose of our lives, is learning to understand the cycles at play in our lives, relationships and in society as a whole is.
You may want to achieve some aim, you might want to follow the advice of a motivational speaker, but if your planets are not correctly, unless this is the right time in your life to follow through, chances are that you will be disheartened rather than being enlivened by the attempt.
All things experience cycles. Some are obvious: the rotating earth causes day and night; our moon generates the ebb and flow of the tides and the seasons’ change. Our energy levels rise and fall in concert with the cycles of the Universe. The geniuses who created homeopathy and Ayurvedic and Chinese Medicine all understood the profound importance of watching when symptoms appeared or changed. It is extremely useful to get in the habit of paying close attention to your energy and noticing when it is going up or down. We want to harmonize with the powerful cycles of the Universe, and it is always much easier to surf the crests of the waves than to try and swim against them.
During periods of low energy, our natural tendency is to try and use some artificial energy booster: a cup of coffee, a soda or a candy bar. Unfortunately, that approach ultimately leaves you more exhausted. It is usually better to be aware of the low energy point and use the time to take a short break and to do get up and stretch, if possible go outside and drink some fresh water. If you ignore your body’s needs for movement, breaks and sleep, it is inevitable that you will not be able t function at your best, and your productivity in all areas of you life will plummet.
The economist Edward R. Dewey was prompted to initiate a life-long study of cycles as he pondered the depredation of the Great Depression that began in 1929, and carried on through much of the 1930s. In 1941, Dewey established the Foundation for the Study of Cycles now based in Albuquerque, New Mexico. (There are three short but interesting free downloads on their website and some extraordinary lists of cycles, many of which have been confirmed over time.).
Over the years the work has branched out in kinds of different directions. There is more and more evidence that many of the major cycles that dominate our bodies, minds, relationships, society and the economy, are largely predictable.
I have known some people who strongly resisted the idea of cycles. It seems to contradict the notion of free will to learn that your life and indeed the whole universe vibrates in a series of regular and predictable rhythms caused by forces that may be unknown and uncontrollable. In fact if you can understand the nature of these cycles you will develop a remarkable degree of personal mastery.
I’m going to spend some time in the coming months explaining how an understanding of the cycles at work in your own life can dramatically improve your health and your sense of control.
“In all things there is a law of cycles.”
— Publius Cornelius Tacitus (Roman Historian, Writer, Orator and Public Official, A.D.56-c.120)
Surviving Airplanes
I’m an extremely frequent flier: in an average year I fly the equivalent of ten to twelve times around the world, or all the way to the moon and part of the way back. So I’ve had to learn all the tricks for surviving countless hours in the air.
Some of them you will know already: keep hydrated, avoid alcohol, move and stretch whenever you can. I’ll soon be posting my jet-lag strategies.
But I wanted to let you know about a product that I’ve been using for years: it’s now called Yarrow Environmental Solution. I’ve certainly found that it’s been very helpful in reducing some of the exhaustion that is a common part of long haul air travel.
There is a piece of unpublished research that seems to confirm that the remedy is having a measurable effect. I wish that I had the time to do a more extensive study to see whether my observations have a scientific basis.
Current scientific models can’t explain how the flower essence could possibly work. Yet my observations and those of many students and patients are that it can be very helpful indeed. Not just to frequent fliers, but also for people who spend a lot of time in front of computer screens or under artificial light.
If you are exposed to any of these things, and find yourself constantly drained and exhausted, you may find this essence very helpful, as part of a package of Integrated Medical care.
Regular readers know that I’m most insistent on full disclosure. So I can reveal that I have absolutely no relationship with the manufacturer, other than buying bottle of their essences.
Technorati tags: Yarrow Environmental Solution Flower Essence Society Biofield Subtle energyIntegrated medicine Integrative medicine Environmental illness
Sexual Health
One of the principles of integrated medicine is that anything that is really good for you should impact more than one system of the body. So for example omega-3 fatty acids will, in moderation, help your cardiovascular system, brain, mood and skin.
There is a good example of this in a study published this month in the Journal of Urology. The research was orchestrated by the Harvard University School of Public Health in Boston, and involved 22,086 American men followed over fourteen years. The findings confirm the importance of lifestyle choices to the risk of developing erectile impotence. Some of the same things that are bad for the heart also dramatically increase the risk of developing impotence. Men who were obese at the beginning of the study were 90 percent more likely to develop erectile dysfunction (ED) than were normal-weight men. Similarly, smokers had a 50 percent greater risk than non-smokers of developing ED. On the positive side, regular exercise appeared to protect against erectile problems. Men who reported the highest exercise levels at entry into the study’ were 30 percent less likely than their inactive peers to develop ED over the next 14 years.
The reason for these associations is primarily to do with blood flow. Anything that impedes blood flow increases the risk of ED, and anything that improves it will likely have a beneficial effect. We already know that people with diabetes mellitus and hypertension are far more likely to develop ED.
The message is very straightforward. If we ever needed any more evidence that smoking and obesity are bad for you, this is it. Stopping smoking, losing weight and taking regular exercise will all reduce your risk of developing ED. And if stopping smoking is a problem, not only do we have new medicines coming along, but I’ve also had some good results with homeopathy and the tapping therapies.
Technorati tags: Erectile impotence Smoking Obesity Physical exercise Integrated medicine
Homeopathy as a Part of a Comprehensive Treatment Plan
I have been using homeopathic remedies for over 25 years, and I have often found them to be extremely helpful.
I part company from many of my friends who are classical homeopaths who insist that using any form of conventional medicine "suppresses" illnesses, rather than curing them, and so should all be avoided like the plague.
As we started rolling out the new integrated model of healthcare, which integrated conventional medicine, lifestyle changes and homoeopathy, many people objected violently on the grounds that ANY use of other, non-homeopathic treatments would prevent the homeopathic remedies from working.
This has come up recently with several common problems: using homeopathic "vaccinations" in place of the real thing; using homeopathic remedies for influenza, to the exclusion of conventional treatments. And now we hear of people being advised to use homeopathy for malaria prohylaxis. This worries me: I have seen people die of malaria, and it isn’t pretty. Homeopathy may be a useful adjunctive treatment and it may also help with any side effects of conventional treatment.
Please don’t play Russian Roulette with your health.
I thought that it would be a good idea to reproduce the following brief article:
Alternative malaria treatment may not work from PhysOrg.com
British health authorities are urging tourists not to rely on alternative treatment such as homeopathy to fight malaria.
[…]
Technorati tags: Homeopathy Integrated medicine Malaria
Adjunctive Homeopathy in an Intensive Care Unit
Although we normally try to get articles quickly, we are sometimes thwarted and they can be delayed in arriving. I have only just got my hands on a study abstract that was published by a research team from Graz in Austria last October. The investigators from the Ludwig Boltzmann Institute for Homeopathy examined the use of homeopathy in a group of severely ill people in an Intensive Care Unit.
This was a double-blind, placebo-controlled trial to see whether homeopathy would be able to influence the outcome of critically ill people with severe sepsis. Seventy people entered the study, and 35 received homeopathic treatment and 35 received placebo, in addition to their regular treatment. The main outcome measure was survival. At day 30 there was no difference between the survival rates of the people receiving homeopathy and placebo. But at day 180, the survival rate in the homeopathy group was 75.8% compared to 50% in the placebo group.
One study does not make a revolution, and it is still early days for this kind of experimental work. Yet two things stand out from this small investigation:
1. The homeopathy was being used as an adjunct to conventional medical care. I sometimes get worried when practitioners of unorthodox medicine say that they would ONLY use herbs or homeopathy. The best approach has to be to combine conventional treatments with those unorthodox ones that can be shown to be helpful.
2. Trained homeopathic physicians did the prescribing. This is important: some studies have foundered because the studies tried to test just one remedy. Yet homeopaths individualize each treatment. So two people may have the same infection, but because they have different personalities and constitutional make-ups, they will receive different treatments.
Technorati tags:
Technorati Tags: homeopathy, complementary medicine, integrated medicine
Homeopathy R.I.P.?
Homeopathic medicine has now been in use for over two centuries since its basic ideas were rehabilitated by the German physician Samuel Hahnemann. And its essential concepts have always seemed strange to anyone with any scientific training. The central idea is that people have a life force that, if disturbed, can lead to illness. The second idea is the "doctrine of similars, " or of "like curing like." If you peel an onion, then your eyes and nose may start to run. So one treatment for a person with runny eyes and nose might be onion. The third peculiarity of homeopathy is the use of super-dilute remedies that are prepared in a very precise way. There is a nice summary article of some of the basic ideas.
There is an important principle in scientific research which sometimes gets forgotten: there are many different types of study and one of the most fundamental of errors is to mix up pragmatic (does it work?) and mechanistic (how does it work?) experiments. Pragmatic studies usually follow on from clinical observations, and even if something is shown to work, it can take years to work out the mechanisms. Aspirin would be a good example: it was used in various forms for over a century before it was discovered how it worked.
In August of this year the Lancet published an article on homeopathy that has been taken to signal the end of homeopathy. In fact in an accompanying editorial, there was a call for homeopathy to be abandoned, altogether. However, in the three months since then, a number of us have been through the Lancet study very carefully, and have found some snags in it. So far the Lancet has chosen not to publish responses to the article, and the authors themselves have, as of now, refused to disclose exactly which studies they analyzed. This is highly unusual, and should give pause to gleeful skeptics who have taken this one study to be the death knell of this form of treatment. Worse yet, the folk who have dismissed homeopathy based upon media reports of the study, without examining the original.
As examples of some of the astonishing problems identified in the Lancet publication: there was no clear statement of aim. This is normally required before you even begin a piece of research. The investigators first look at every homeopathic study that they could find and then decided which studies to include. This is again a very unusual way of doing things. And then there are a lot of questions about the statistical analysis. We all know that you can use statistics to prove almost anything that you want to, and the debate about the appropriateness of the methods used is going to go on for a very long time.
The next time that somebody tells you that homeopathy is now a dead duck, tell them that the study is still being discussed. And as I have said on previous occasions, we do not make progress on the basis of one single paper. Even Watson and Crick’s model of the structure of DNA had to be confirmed before it was accepted, and going back further, some of the brilliant insights of Albert Einstein were not confirmed for almost fourteen years. But this study has already led to the Swiss Government deciding to reduce reimbursement for homeopathic treatment.
I have also seen some violent criticism of a six-year study involving around 6,500 patients who attended the Bristol Homeopathic Hospital in England. This was a simple naturalistic study that asked a simple question: of all the people who visited the hospital, how many felt better afterwards? This is the kind of audit that is being done all the time to see how people have got on with a hospital or a treatment. It does not "prove" or "disprove" homeopathy, it just asks people how they feel. And most said that they had benefited. To criticize it for not being randomized or placebo controlled is a bit like going to an Italian restaurant and complaining that they don’t serve Chinese food!
Homeopathy is no "cure all," but I will not abandon it unless we get some far more impressive data than that from the Lancet paper, for not only have I seen it work in patients and in animals with monotonous regularity, but because behind the scenes, we have been seeing more and more research coming not from patient studies, but from physics and cell biology laboratories, that seems to be giving the specialty a firm theoretical footing.
I shall continue to report both the positive and the negative studies as they are published, and offering guidance about how we can use different forms of treatment in combination.
Technorati tags: homeopathy
