Archive for the ‘Alternative Medicine’ Category

Why is getting kicked in the balls worse than pregnancy pain?  After a few years, you don’t hear guys saying, “Well, I wouldn’t mind getting kicked in the balls again…”

Pain is one of the most difficult “symptom” to deal with in medicine.  I didn’t really believe the range of pain until I started working in the field and seeing people’s different responses to pain; from kids writhing in pain even before I touch them to a man not even flinching when I debrided his wound.  There are many examples in between where people range from yelling to a simple ow (in Croatian this is translated into “ajoj”).  So for a medical doctor, the extent of diagnostics depends heavily on “guessing” how the patient’s pain translates into symptom or a real diagnosis.

For me, life can’t be without pain.  For example, people feel angina pectoris from a stressful breakup to actually having dying cells from myocardial ischemia (heart attacks).  So I am constantly in “some kind of pain”.  So why do people feel pain differently?  Nobody knows.  There are many types of pain ranging from somatic, visceral, psychosomatic and central.  Putting aside all of the medical terminology, these are pain that you feel depending on location.  If you cut yourself, for instance, you will feel a sharp type of pain.  However if you notice, your pain will dull with time, despite the cut being there.  Itching for some is sometimes painful for others.  So the diagnosis of pain is a difficult one and as a doctor, we are trained to use the worst diagnostic tool (besides the Bristol Stool Chart) to gauge the value of pain that the person experiences.

Pain, being the main symptom of most patients, is then a very confusing symptom to deal with.  What is important for us to know are the details of pain and that is done through SOCRATES (I am sure your doctor has asked you at least some of these questions to narrow down his or her differential diagnosis).  SOCRATES stands for: Site, Onset, Character, Radiation, Associations, Timing, Exacerbating factors, and Severity.  Some pain symptoms, no matter the severity, is pathognomonic for certain diseases (i.e., RUQ pain radiating to back is indicative of acute pancreatitis).  There’s a cheat sheet.  Don’t think we’re all clever.

However due to the controversy on the news about opioids (a type of pain medication) being over-prescribed for CHRONIC pain management, I would like to talk about that here.  So what is chronic pain?  What are the different types of pain medication and what do they do?  How do you deal with that pain?  These are all hard questions and pain research, like most medical research, is relatively young.  However since pain is subjective, it is ethically hard to figure out how to research what pain really is.  For instance, a woman giving birth and tearing her vaginal canal would rate a bad smiley face, whereas a yuppie who had a silver-spoon life would cry at a papercut (NOT stereotyping, patients I’ve had).  Even if you try to measure biochemical reactions of pain neurotransmitters while unethically inflicting pain on your subjects…

…you would get zig-zag, scatter-type graphs, despite trying to compensate for genetics, culture, gender, age, etc.  Therefore, pain is a VERY open field and is still trying to be understood.

So What Is Chronic Pain?

headdesk

Meh.  That is like asking again, “What is pain?”  Chronic pain is some sort of, usually and hopefully, dull pain that effects a certain region of your body or even sometimes your entire body.  The latter is harder to figure out, but usually goes away with massages and feel-good activities.  However, most of these patients are in the older population, usually have had some sort of injury or surgery, and are prescribed opioids to manage their pain.  Yes, that might seem like the lazy thing to do, but a doctor cannot manage a person’s life as much as they would like to.  On top of that, people really don’t like following advice until they get scared with death (one of the side-effects of opioids).

That said, and in my field of rural emergency, I encounter many patients who are chronically on opioids and arrive on the field because of diffuse chronic pain.  It’s a frustrating aspect of my job, where the only thing I can do is alleviate the acute symptomatic flare with more painkillers.  I won’t go into the details of why someone might have chronic pain, but it is usually mismanaged.  So how do we stop this?  First we have to understand how we prevent pain, and before we do that, we have to understand the source of the pain in the first place.  So basically secondly, we have to understand how we can prevent pain.  Firstly…never mind.

So yes, pain.  SOCRATES.  With SOCRATES, you can PROBABLY figure out why the patient is in chronic pain.  What does chronic pain mean to you?  Does that mean that you’re immobile?  Can you do normal functions at home?  If you are hindered due to painful events, it does make life difficult and can cause stressful situations at home and at work.  That annoying pain that you’ve had due to twisting your knee when you were 21 can suddenly become debilitating when you’re 35.  Does that mean you’re unhealthy and need some sort of medical intervention?  All these questions related to pain, I find, are related to the most important, and most forgotten, part of modern medicine; which is QUALITY OF LIFE.

If you can’t maintain your quality of life, then you are basically not fulfilling the WHO definition of health (physical, mental and social health).  When this happens, it causes stress within yourself and your surrounding community.  So how do most people alleviate that?  Through taking prescription pills.  Remember how doctors have thousands of patients and will say?

“Take this for a few weeks, please exercise [insert part of body here] and follow healthy habits and come back for a checkup.”

Most people don’t live a healthy life, which could exacerbate pain (sedentary lifestyles make some chronic pain worse).  Some people have to get back to work and physically do repetitive movements, which is the cause of the pain in the first place (please lift with your legs!).  Like I said, most doctors don’t have time to mediate lifestyles, so this is up to the population to understand and compensate.  If I were a mechanic, I can fix your brakes and tell you not to brake so suddenly and plan your driving route.  However, you probably would go back to habit and drive like a maniac.

If you don’t want to be stuck on opioids, lifestyle changes are the key to chronic pain management.  Since every case is different and every person has their own subjective opinions on pain, it is hard to say what the best course of action is.  However, if you want your quality of life back and realize that even opioids are not working for you, then it is time to try different variations of pain management which does not require addictive medication.

The Good Stuff?

In a few quick paragraphs, I would like to go into a few common painkillers, and quickly describe what they are good for.  You can research these online to see what works for different occasions, but everyone reacts differently to pain medication because nobody knows where their pain is coming from.  So to understand the type of pain, you have to understand what alleviates it.

Aspirin

Aspirin is described as a near-perfect drug.  Being used for a LONG time in its “alternative medicine” form as a hot drink to relieve fevers, the base of aspirin is (you can just Wikipedia this instead of me writing out a synopsis) an anti-inflammatory and also a COX inhibitor.  Long story short, this type of inhibition blocks the interleukins (biochemical messengers) that cause pain and fevers.  Besides being bad for your stomach by not blocking acidity production and protection thus causing ulcers, there are not many other side-effects (super fever by taking too much).  This universal painkiller is good for headaches, muscular cramping and joint pain.

Acetaminophen

Another commonly used pain killer is APAP (paracetamol, Panadol, Tylenol or acetaminophen).  Found through a fluke, APAP is amazing at cutting off pain and is still poorly understood.  It has a COX2 inhibiting property, which makes it act like aspirin in a more specific way and reduces fever, but it is also somewhat bad for your liver (do not take with alcohol!), since it is metabolized in it.  There is also a mechanism where it blocks pain transduction in the spine itself, so it is very good for peripheral pain symptoms that are not due to inflammatory effects (sprained ankles and such).  This painkiller is combined with other potent painkillers to create combinations for “hard or heavy” pain, which is taken chronically and can cause potential liver problems later in the future.  I would use APAP for fevers and not chronically, although it does help.

Ibuprofen and Other NSAIDs

NSAID stands for Non-Steroidal Anti-Inflammatory Drugs.  From the name and a little bit of logical medical knowledge, you can derive what it does.  There are MANY drugs in this category and they all do the same thing to different levels of relief.  Since they are an anti-inflammatory, they can reduce immune reactions in your body, creating a range of relief from the inflammatory reactions that cause arthritis to the inflammatory reactions that cause fevers.  In that sense, they are good when your joints are inflamed when you twist them or injure them in any way.  Since they work on different places of pain management, I like to alternate NSAIDs and APAPs daily to effectively reduce ACUTE symptomatic pain.

Opioids

Opioids are AWESOME!  Despite being the derivatives of heroin, modern biochemistry and chemistry have honed their art to making key-lock mechanisms for the super-addictive nature of the natural painkiller (eat that, you f-ing hippies!), opium.  Basically working on natural opioid receptors, these natural painkillers will block almost most types of pain.  Unfortunately, they are still very addictive and if used chronically, they will cause upregulation of the receptors and you will need a larger dose to get the same level of relief.  Most chronic pain patients are treated with opioids and thus the controversy in modern medicine.  Although prescribed to alleviate pain during physiotherapy, most patients will subconsciously feel pain after and discontinue their physiotherapy in lieu of a quicker pain fix (Dr. House?).

The Chronic!

When I was training for triathlons, people would tell me to get high so that I could lift weights better.  I wasn’t a smoker so it really irritated me, but I could tell you that it worked.  I could hardly feel pain for the few hours that I was high, but that comes with any downer high (like opioids).  Since medical marijuana became a “thing”, many chronic pain patients are on the chronic (and many more who are not in pain).  However, the Mary has always decreased the amount of productivity in the working class, so I will not talk about this further due to a lot of conflict from recreational users advocating the “goodness” of a “natural” drug that has mental side effects, who could easily be sipping willow bark tea (aspirin) to lower their pain levels.

The Alternative?  Better Than Drugs!

So why don’t we just alternate drugs and treat CHRONIC pain through mixing pills?  Well, it’s complicated.  If I wasn’t there to regulate, would you really comply?  Honestly, would you?  And the second is that chronic pain is different.  Once you start taking pills for years, your body will eventually get used to the pills (will NOT explain upregulation, Google it).  So is there a better way?  You bet there is!  So what is the alternative, you ask?

You won’t like it, but the healthier option is (obviously) a healthy lifestyle.  That might be a vague concept, but chronic pain disappears when you are in a state of less stress.  Imagine chronic muscle pain and then getting a massage.  Imagine your boo-boo when you scrape your knee and your mother blows on it.  Imagine your back pain when you are having amazing sex.  Yes.  All these things block pain receptors in much the same way that pharmaceuticals block them and if you want to know the biochemistry and physiology behind it, feel free to use Google (I don’t get paid enough to type out answers, but if you want to know over beer, feel free to contact me).   So reading through all the chronic pain management articles on the inter-web from variable sources, I based it to TRAIN (nooooooo!).

Train

Yes.  You have to exercise.  You have to regulate your body to stretch your muscles and increase circulation.  Most people will feel pain in the beginning and it will be overbearing, but after a few weeks, your body will compensate and down-regulate those pain receptors and you be able to manage the symptom of pain.

Rest

The body needs to regulate itself and most people are in the constant state of bad stress.  When you don’t get enough bed rest, your body will always be in the state of shock and stress causes pain (again with the biochemistry).  Meditating on the pain can also alleviate the pain and, done properly, it can also relax the part of the body disturbing you.

Antioxidants

Besides stopping smoking and drinking (which most patients won’t do), antioxidants will combat these toxins that you are putting in your body every day.  If you follow any type of nutrition website, anything can be an antioxidant, but try to include potent antioxidants.  By creating a protective barrier against oxidizing stress on your body, you can better alleviate symptoms due to (well…) smoking and drinking.

Information

This might be the most important aspect of medicine that people seem to forget.  Trust your doctors, but always question their decisions.  Be well informed on how to increase your quality of life and the more you share with your primary physician, the more they are informed on how to manage your lifestyle so that you can further improve your condition and not rely on heavy medication to alleviate your pain.

No!

“Just say no!” was the 1990s anti-drug campaign I grew up with.  These medications are made to alleviate pain while you recover and not to keep you in a constant state of addiction.  During that CNN interview, a 65 year old man had to go to rehab to kick his oxycodone (opioid) habit that was prescribed to him to deal with his pain.  Sometimes, you have to say no to your physician and then better inform him of what you are dealing with.

After all, it is your health and your QUALITY OF LIFE.  Or occasionally get a COX blocker!  Ba dum tssh!

Fun Stuff!

Feel like being fancy?  Learn how to say OW! in different languages.  Click here.

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I’m BACK!!!

I am sorry for not keeping up my blog.  It’s been a while since I’ve been motivated to sit and write and continue my normal lifestyle.  Since I’m getting closer to my 36th birthday, I figure that I should be what I was when I started that first half of life.  I was a better, more patient and happier person.  So after the bullshit I went through to become a medical doctor, I hope that I can continue on with helping people and not be blocked by meaningless borders and bureaucracy.  So I hope you enjoy my insights into good health and if you have any questions, you can direct them here.  If you have any criticisms, you can direct them here.

It’s been a while since I wrote anything about alternative medicine and since I have patients now and a little bit more cases that I can relate to, I’ll start posting articles up on how to use preventive medicine at home!

So I moved here the weekend before the 1st of July.  I was in the City of Cres and waited for my colleague to come and drop me off in Martinščica, a small outskirt camping town and docking marina on the west coast of the Island of Cres.  As we pulled into the tiny town with a little over 100 local inhabitants, I immediately fell in love with the heart-shaped bay and the collection of houses that line the coastline after the serpentine drop from the top of the hill from the main road (9 km away).

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I immediately felt relaxed and let my guard down as we sat at Sidro with my hyperactive nurse from Rijeka.  After a few dips in the sea, my colleague left and left me alone to open the small tourist clinic in the middle of Martinščica.  My nurse, full of energy, decided to clean up nature and made me clean all the pine cones, basically to make the clinic more presentable.  However, she quickly lost will and energy, leaving me to finish cleaning up the exterior and to clean up the trash that was laid around by the people who trimmed our trees.

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I also lost a lot of energy and soon began to take more and more naps outside.  The temperature got warmer and the only way I could snap out of it was to jump into the sea, which was at that time a crisp 20 C.  Bura, a cold west wind coming from the mountains, was blowing cooling down the temperatures, but still I felt like something was always dragging me down.  I slowed down on smoking, which usually gives me a bunch of energy.  Nothing was working and I became worried.

Then on one EARLY morning (thanks to mosquitoes), I woke up to a wonderful smell that filled the clinic and decided to go jogging, since the morning was cooled down by a drizzle from the night before.  I suddenly realized that it was a mixture of different aromas and narrowed it down to the aromas of pine, rosemary, lavender and immortelle. 

My sister, who is into aromatherapy for her clinics, got me interested in alternative, hippie techniques and therapies to sometimes disprove her methods, but more importantly find a reason why they seem to work.  I’ve always used lavender as a sleep aid, and during that morning jog, I realized that this entire island is full of wild lavender, rosemary, immortelle and pine!  That did not help the energy level as I took deep breaths of aromatherapy during my 3 mile run!  I eventually came back to the clinic, showered and passed out until my first patient woke me up from my aromatherapy-induced nap.

I also learned from a newly acquainted friend, who is from Martinščica, that there were cases of people with asthma or chronic obstructive pulmonary diseases that have left Cres cured of their chronic pulmonary diseases.  This is my theory why.

ABOUT CRES

According to Cres-Adventure.com, Cres has the least inhabitants in the whole of the Mediterranean.  Therefore, there is a lot of preserved flora and fauna.  Since it falls on the 45th parallel, Cres has both continental and Mediterranean climates.  This mixes the local flora into both evergreens and pines to seasonal plants.

PINE

Pine is good for bronchial infections as it is both antibacterial and an antiseptic.  Making an oil out of pine and using it as aroma therapy can fight against lower respiratory infections.  Pine oil also works as an expectorant, breaking up mucus and clearing it out from your lungs.  Steam inhalations work the best to clear up the lungs, but because the Island of Cres is covered with pine and the aroma is carried through salty winds, the people living on this island is constantly breathing in aromas of pine and its beneficial properties.  Pine is also great as a muscle relaxant, which is probably the same reason why I am having troubles getting motivated to move about and jog or bike.

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IMMORTELLE

When my colleague who has a summer house on Cres said that she missed the smell of Cres, I didn’t get it at first.  Then she went to explain the smell of this yellow flower and looking into it, I found out that she was talking about immortelle.  I didn’t even realize these flowers were EVERYWHERE, but after going two steps into the nature, I found FIELDS of them!  Immortelle gets its name, because they stay the same shape when they’re dead and dried.  Oils made from this flower are rich in italidone, a ketone that help in the absorption of hematomas and has an effect on tissue regeneration.  Traditionally, immortelle is used against asthma, liver problems, migraines, psoriasis, dilated veins, etc.  As an inhalant, immortelle can also break apart mucus, reduce irritating coughs as well as having an inflammatory effect.  According to an article from Dr. Nina Bašić-Marković, the peppery smell of immortelle also invigorates the mind and reduces lethargy and depression.  Since the clinic is surrounded by a field of immortelle, I’m very unsure about that as we lose a lot of willingness to work.

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LAVENDER

Lavender can be found all over the Mediterranean and is known all over the world for its anti-mosquito properties (although it never works), it’s sleep-inducing properties and it’s amazing ability to keep moths away from clothing.  Due to high levels of camphor and esters, essential oils are not suitable to be used with small children and pregnant women.  One article mentions that lavender is great for the common cold, rhinitis, cough and sinusitis.  Its aromatic properties have the same effect as pine and immortelle, adding to the muscle soothing and pulmonary healing effects.  However lavender has a sedative effect on the heart muscle and thus is great for high blood pressure, palpitations and tachycardia!  Being an antiseptic and analgesic, lavender is an ideal choice for treating burns and reducing scarring.  Besides many other uses, the most important effect of lavender is its ability to reestablish balance to the mind and the body.

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ROSEMARY

It is believed that rosemary strengthened memory and also is the symbol of fidelity. The smoke from burnt rosemary was inhaled to protect against brain weakness and dizziness, and the herb was burned in schools and universities to inspire the pupils.  Until the twentieth century, the branches were burned with juniper in French hospitals to purify the air.  Rosemary is abundant in the Mediterranean and blooms in late winter and can be found very close to the sea.  Rosemary, like many other natural plants, is full of esters and aromatic -ols that serve as an antiseptic, astringent and antioxidant.  This plant can relieve rheumatic and muscle pain, relaxes nerves, improves digestion and appetite, and increases sweating.  Vapors from its essential oil can reduce congestion and stimulates the nervous system to increase energy.  It encourages old, dry skin to produce its own natural oils and reduces canker sores!

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MAKE YOUR OWN SCENTED OIL!

So basically, I realized that the aromatic mixture of these four plants have increase my lung capacity and I don’t feel the need to smoke.  I can breathe better, but my muscles are so relaxed that I do not feel like jump starting anything.  With this in mind, I think I found the perfect mix to have whenever you have a hard day at the office, or if you have sore back and a significant other to rub oils into your back!  I have neither.  Thus I decided to make my own Cres mixture of aroma therapy and see if I can recreate this relaxing sensation for my friends.  Looking op on Wiki How, I found a simple way to create a mixture of these four herbs and see if there is something to this alternative medicine aromatherapy doo-hickey!

Sterilize your jars and lids

1. Place them in a large pot of boiling water for around 5 minutes

2. Allow the jars and lids to cool and air dry.

Choose your herbs

1. Chop up enough of the fresh herbs to fill up the jar.

2. Fill the jar with the freshly chopped herbs, and compress them.

3. Heat about 0.250 L of light unscented oil in a small saucepan until it reaches 71.1C.

4. Use a meat or candy thermometer to obtain a precise reading.

5. Pour the hot oil over the fresh herbs in the jar.

6. Use the knife blade to move the oil and herbs around to release any air bubbles and to seal the lid.

7. Allow the jar to cool until you can handle it.

8. Use a label and marker to indicate what blend is in the jar.

9. Pick a cool, dark place to store the jar for at least 1 month.

10. The oils from the herbs will infuse with the oil in the jar to make essential oils.

11. Aromatherapy essential oils must be stored in the dark to prevent light from breaking them down.

 

SOURCES

1. Pine

2. Immortelle and Lavender

3. Rosemary

4. Oils