Friday, October 16, 2009

To cut or not to cut.....that is the question.

Now that I finished the marathon, I am back to blogging. Didn't relaize it has been the whole summer but good to be inspired again. On the phone with my local law enforcement friends today and just happened to hear a sliver of an illness. Of course for those who have met me, I had to start my "interrogation". (the kids will attest to the fact that if I hear anything medical come up in conversation.....there I go...blablablablabla). So "lady T" had a very common ailment of right upper quadrant pain. With traditional western medicine, we think of the body part and not the person so I already had a diagnosis and treatment for her. (And all I heard was 4 words..pain, abdomen, right side....western medicine has programmed me to be so uncaring that if I was rushed in an office.....I would stop the conversation and write a script!) Of course being the compassionate doc that I am, I listened more to "lady T the person". I knew from her voice she had patience, experienced with the stress of triage, hestitant on going to the doctor. (I don't blam her....I dont trust doctors....especially ones who force me to take swine flu vaccinations so I dont infect others with an illness I don't have from a vaccination that has been fasttracked!) Don't have to get into the details of the complaints but it brought me to this point. During holidays, especially in this economy, stress is high, exercise is low, sunshine is gone and hot foods and coffee are a-plenty. In considering all of the above, people with gastritis/ulcers/stomach irritability will start to blossom about now, full bloom will come in the days between xmas and new years. We as a society are putting nasty things in our mouths that were never meant to be created. Foods are genetically engineered to taste soooo great and make you feel soooo great for a short time. Then there is the remorse of "I can't believe I ate the whole thing", or "I should have stopped at 2", or "I am going to have to fast for a week now" or "now I will have to spend 500 hours on the bike". Well, the ramifications to bad behavior are: stomach upset. The body knows what is healthy for it and will let your brain know...."this much coffee is not good for you so I am going to gnaw at your right side for a couple of minutes every hour". Stress of winter season also brings sickness to the community, people missing work and staying home, having to fill in for extra shifts, fielding complaints from others who also feel lousy, more anger on the highways causing accidents and traffic jams, leading to being late for work, eating lunch too fast, having more indigestion and side pain,not being able to concentrate at work leading to poor sleep and getting sick....etc.
Without coming up with an exact diagnosis, the first thing I would try to get people to embrace the comforting things of the season. Nature has built so many things that help us through the dark months. Think warm fire, soft blanket, comfortable slippers, roasted nuts, warm cocoa, cuddling with a love one to stay warm, seasonal holidays with family. There are great answers to stress that we kinda just save for snow days but should be taking advantage of now. At Harvard, Herb Benson taught me that meditation and the relaxation response will take care of the majority of stress related illness without even prescribing one medicine. No doubt, this is difficult to learn and doesnt happen overnight. I now put on my western doctor hat and tell most folks, I have the power to make things go away in seconds with chemicals that may kill you, but if you are in a hurry and have prescription drug coverage, I am there for you! (Such an american answer to treat the symptoms fast and not worry about the cause) And while on the topic, you should always see a doctor for other possibilities....gallstones, kidney stones, liver disease, cancer. In fact, most docs due to the emminent threat of being sued, will initiate the treatment plan saying, it may be these other diseases but I will treat for the most common one first so don't think about cancer or surgical extraction of a gallstone. Like saying, "you can drive my Porsche, and it has alot of horsepower with a difficult to control midengine oversteer that will cause you to lose control and hit the median and die but that probalby wont happen so enjoy!" As Wayne Dyer says, don't let the negative meme (thought) enter your mind to begin with.
So back to belly pain, the fast answer is stress equals poor digestion and stomach erosion from increased acid production. Chronic over production of acid by the stomach will digest food but will also digest itself. Yes, if the stomach has an imbalance between the mucous lining it makes to protect itself and the amount of acid it makes to digest the food it carries, ulcers happen. These start as erosions/scratches/rough spots on its lining. With continued acid production, poor mucous production, high ingestion of damaging foods-coffee, caffeine, tomatoe, chocolate, advil, alcohol. The erosion/scratch/rough spot will grow and become louder. Symptoms will go from a gnawing to the solar plexus to radiating pain from the right side to pain to the right low back. Food will soon become irritating to the pain loose bowel movements occur, sleep gets interrupted early am.....Fast treatments would be avoid the foods mentioned, pepcid or zantac twice a day for 2 weeks, smaller meals more frequently to avoid overstretching of the irritated stomach. Some docs go straight to the "proton pump inhibitor meds like prilosec, prevacid, nexium. These are very powerful and shut off all acid to help heal the lining. Problem I see is that docs prescribe but don't advise diet change. So bad habits continue and patients get placed on strong meds for years. I tell all my patients, the ppi's(proton pump inhibitors) were release with a warning not to use past 3 weeks. No acid means poor digestion, bad bacteria overgrowth, poor mineral, vitamin and antioxidant absorption, poor healing and poor health. Food products like fennel, peppermint, ginger and anise have always been used to "calm" the stomach and act as "carminitives". I have acutally picked up a tea blend from Teavana in the Woodfield Mall containing: peppermint, chamomile and green tea-great for coffee substitute and warm with the antioxidant EGCG. Avoidance of very difficult to digest meat and dairy products for about 2 weeks also important. If no response, I have several treatments in acupuncture that would help in the healing process in addition to digestive enzymes until healed. There are also very good practitioners in reflexology, reiki, and some chiropractors who can help initiate the healing process with hands on healing.
I always welcome radiology studies like ct scans of the abdomen, ultrasounds of the gallbladder (especially with a family history) and maybe even kidney tests. One caveat is if there happens to be a stone in the gallbladder that was incidental and the pain is present, a surgeon will always say, when do you want to schedule for surgery? One may or may not need to be cut but the squeeky wheel always gets the most oil. "If you complain, he will cut it out".
A final note is during this time of year, meditation for 10-20 minutes twice a day will alway help your reaction to daily stressors. Depak Chopra suggests deep and quiet meditation at least 20 min/twice a day. Herb Benson suggests do it when you can "mini's". I like to include breathing 4-7-8 with yoga twice a day and it helps me smile for an entire 8 hours of working in a busy emergency room during peak H1N1 season (which will be another blog!)