The Self-Treatment Guide

I ran across this rather amusing anecdote posted by GruntDoc about the guidelines for chiropractors in the ER, which I won’t quote from since he prefers that you read it in context.

However, what was also interesting was a comment about rebound headaches left on the post by A Bohemian Road Nurse that reads as follows:

I’ve also found a lot of people with constant “migraine” headaches whereby Immitrex, narcotics and NSAIDS are not working are really having “rebound headaches”. My sister, who suffered from just such a headache merry-go-round didn’t believe me about the existence of rebound headaches. But she reluctantly tried my suggestion of weaning herself from pain meds. After three days of misery, she was headache free. It worked. Now, she only gets the ocasional “real” migraine, around her menstrual cycle, for which Immitrex DOES now work. (I know this doesn’t cover everybody, but it is a thought to consider for some people with lots of headaches….)

I first heard of rebound headaches a few years back from (I believe it was) Dateline NBC. The gist of the story was that constant use of NSAIDS like Ibuprofen can actually lead to worse headaches once the medication wears off.

It eventually turns into a vicious cycle.

I can’t help but wonder if there might not be a similar “rebound back pain” associated with over-reliance on pain meds for the treatment of back and neck problems. It would explain why a lot of minor injuries develop into chronic problems.

I’m sure there is a flaw in my logic somewhere… I’m just thinking out loud.

Dean

I ran across this post on Dr. Flea’s blog this morning that was too good not to share with you. For those of you unfamiliar with Flea he is a pediatrician and one of the more prevalent medical bloggers.

This quote is from his response to the question, Why Do You Blog?

Our culture is suffused with messages telling parents that their children are sick, or potentially sick: one sniffle away from certain doom. Flea’s message is that American children are the healthiest children that ever lived on planet Earth. We should celebrate our good fortune.

The culture tells us the children are defined by series of capital letters: ADD, ADHD, ASD, PDD-NOS, OCD. Flea wants children to be called by the names their parents gave them.

Pediatrics today consists of daily exercises in over-testing, over-diagnosing, over-treating, and over-admiting to hospital. Flea wants the folks to know that often the best thing to do for a child is to keep him or her the hell out of the pediatrician’s office!

Pediatricians who write for newspapers and magazines produce icky, squishy pap that bears only the faintest resemblance to expository writing, and that is astonishingly void of original points of view.

Flea is trying to keep it real.

Nearly half of the low income, nutritionally-vulnerable Latino children
surveyed by Penn State researchers in WIC clinics were treated with
herbs by their caregivers for common ills such as diaper rash, colic,
teething symptoms, stomachaches, coughs and colds.

Although herb use was higher among the Latinos (48.4 percent),
over one-third (31.4 percent) of the non-Latino WIC clients surveyed
also used medicinal herbs for childhood illness. The herbs most
commonly used were those with relatively low risk for adverse effects,
including aloe vera, chamomile, garlic, peppermint, lavender,
cranberry, ginger, Echinacea and lemon.

The study is the first to report on herbal use by participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). WIC helps low-income women, infants and children up to age five by providing vouchers to purchase food, education about
healthful eating and referrals to health-care providers.

Dr. Barbara Lohse, associate professor of nutritional sciences
who led the study, says, “Nutrition professionals and WIC educators
have hesitated to talk about herbs for children because they feared
that it would encourage acceptance and, perhaps, cause people to start using them. Our study has shown that more WIC clients than we thought are already using them, mostly in moderate and appropriate ways. However, because some herbal use has the potential to do harm, we urge herbal education in WIC clinics.”

The study is detailed in the current (February) issue of the Journal of the American Dietetic Association in a paper, “Survey of Herbal Use by Kansas and Wisconsin WIC Participants Reveals Moderate, Appropriate Use and Identifies Herbal Education Needs.”

Lohse began the study when she was an associate professor of
food and nutrition at the University of Wisconsin-Stout and continued
it when she joined the faculty at Kansas State University. Her
co-authors are Jodi L. Stotts, Penn State research assistant and former
instructor at Kansas State, and Jennifer R. Priebe, a clinical
dietitian with San Luis Medical and Rehabilitation, Green Bay, Wis. At
the time of the study, Priebe was a graduate student at the University
of Wisconsin-Stout, Menomonie, Wis.

The researchers surveyed 2,562 caregivers with children living
in Kansas and Wisconsin who were attending a WIC clinic. Child herbal
use was reported for 1,363 of the children ranging in age from 1 week
to 17 years. The majority of the children treated with herbs were
younger than age 5.

The caregivers who participated in the survey consulted a
variety of sources about the use of herbs to treat their children
including family and friends, the news media, the Internet, medical
doctors and other allied health professionals. However, family was, by
far, the most popular source of information and was the only source for
46.9 percent of non-Latinos and 73.2 percent of Latinos.

The reasons cited by the caregivers for use of specific herbs
varied. For example, aloe vera was used for burns, cuts, and rashes as
well as gastrointestinal problems, asthma, colds, ear infections,
fatigue and urinary symptoms.

Although most of the herbs that the participants reported
giving to children were those with relatively low risk, the effects of
long term use and interactions with prescription and over-the-counter
medications are unknown. In addition, ten herbs with known safety
issues, including St John’s wort, kava and red clover, were also given
to children and taken by the caregivers themselves.

The researchers write, “Although it may be tempting to say
that, ‘because little data exist on the safety of herbals during
pregnancy, when breastfeeding, and in children, use of these products
should be discouraged,’ the reality is that herbals are widely used in
these populations. Likewise, recent findings such as the inefficacy and
adverse reactions from Echinacea use illustrate the need to provide an
educational venue and to conduct educational research to formalize
herbal education within the WIC clinic culture.”

St. John’s wort (hypericum perforatum) is one of the five best-selling
herbs in the United States. It is used by many to treat the symptoms of
depression, and many prefer it to prescription medications such as
Paxil® and Zoloft.

However, the herb has been the subject of growing
concern about its interaction with birth control pills, the blood
thinner warfarin, and cyclosporin, a medication used with those who
have received organ transplants. A new study examining its effect on
pregnant women and those who are breastfeeding contributes to the
evidence that the product should be used with caution.

A New Study

The new study, entitled “St. John’s Wort (hypericum perforatum):
Is It Safe During Pregnancy, Breastfeeding and With Prescription
Medications? A Systematic Review,” will soon be published in the
Canadian Journal of Clinical Pharmacology. It is one in a series that
systematically reviews the evidence relating to the safety of herbs
commonly used during pregnancy and lactation.

The study was conducted by a team of Canadian researchers consisting of
the principal investigator Jean Jacques Dugoua, ND, MSc (Cand.),
University of Toronto, Sick Kids Hospital, Toronto Western Hospital,
Truestar Health and Wellness Clinic, and the Canadian College of
Naturopathic Medicine, Toronto, CN; and co-investigators Edward Mills,
DPH, MSc., PhD (Cand.), Department of Epidemiology and Biostatistics,
McMaster University, Ontario, CN; Dan Perri, MD, BscPharm, FRCP(C),
Department of Clinical Pharmacology and Toxicology, University of
Toronto, Toronto, CN; and Gideon Koren, MD, The Motherisk Program,
Hospital for Sick Children, University of Toronto, Toronto, CN.

Dr. Dugoua is presenting the team’s findings at the 21st Annual Meeting of the American Association of Naturopathic Physicians (http://www.Naturopathic.org), being held August 9-12, 2006 at the Oregon Convention Center, Portland, OR.

Methodology

The aim of the study was to systematically review the literature for
evidence on the use, safety, and pharmacology of St. John’s wort
focusing on issues pertaining to pregnancy and lactation. The
investigators searched seven databases for reports relating to the
herb. The databases included AMED, CINAHL, Cochrane CENTRAL, Cochrane
Library, MedLine, Natural Database, and Natural Standard. Each database
was examined in duplicate for data from its inception. Unpublished
research and bibliographies were also included. Data were compiled
according to the grade of evidence found.

Results

The researchers found varying levels of scientific evidence on the
efficacy of use for different conditions; low-level evidence of harm
during pregnancy; and strong evidence of side effects during lactation.
As St. John’s wort interacts with a number of medications due to its
effect on cytochrome P450 enzymes, this may account for some of the
findings.

Conclusions

The researchers concluded:

– Caution is warranted when using St. John’s wort during pregnancy and lactation.

– St. John’s wort may interact with medications prescribed during pregnancy.

– During pregnancy, a case study and some animal studies reported lower birth weights with use of St. John’s wort.

– Strong scientific evidence showed that St. John’s wort consumption
during lactation did not affect maternal milk production nor affect
infant weight, but may cause colic, drowsiness or lethargy.

– St. John’s wort showed strong scientific evidence of being an
effective aid in combating mild to moderate depression and low-level
evidence for other conditions.

Recommendations

The authors urge women not to assume that because herbs are labeled
“natural” that they are safe. They recommend all pregnant and lactating
women consult a licensed, health care professional before consuming any
herb or medicine in general, and St. John’s wort in particular.
Finally, they recommend that any woman experiencing depression let
their physician know immediately.

The following is a press release from June of 2004 that I just happened to run across. It was very brief and, unfortunately, did not include the citation to the NEJM article. However… I thought it was interesting, both because of the content, but because it illustrates that conventional medicine IS doing research on natural remedies.

Breast milk has a compound that destroys skin warts and could protect against cancers

Swedish scientists have found that breast milk contains a compound that destroys skin warts, it could also protect against cervical cancer and an array of fatal diseases. The human papilloma virus causes skin warts. It is a very common virus.

The scientists tried applying human breast-milk to the skin and found that the human papilloma virus was killed as a result (the virus in the warts). The virus, in these cases, had been resistant to traditional medical treatment.

Scientists are calling the compound Hamlet. You can read about this discovery in the New England Journal of Medicine.

Dr. Catharina Svanborg, Prof. Clinical Immunology, Lund University, Sweden, said that this discovery could have relevance for the treatment of cervical cancer. She said the virus found in warts is quite similar to the virus found in cervical cancer.

They plan to carry out a small trial on women who have cervical cancer.

The human papilloma virus comes in many forms – in fact there are at least 130 types of them. In the case of cervical cancer, it is caused by the sexual transmission of two of them.

Millions of people have the virus in their bodies, but not all become ill as a result.

The scientists found that when they applied the breast milk to patients with warts, some of them quite unpleasant ones – plantar warts that attack your feet – they found that the warts shrank by over 75% within three weeks. 75% of the patients got rid of their warts after the second treatment.

One of my fellow barbershoppers sent me this in an email and I thought it was worth passing on. It only takes a minute to read and could save the life of someone you love…

Stroke: Remember the 1st three letters… S.T.R.

During a BBQ, a friend stumbled and took a little fall - she assured everyone that she was fine and had just tripped over a brick because of her new shoes. (They offered to call paramedics, but she declined.)

They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening.

Ingrid’s husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm, Ingrid passed away.) She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today.

Some don’t die. They end up in a helpless, hopeless condition instead.

STROKE IDENTIFICATION

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke… totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

RECOGNIZING A STROKE

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.

Now doctors say a bystander can recognize a stroke by asking three simple questions… so read and learn:

• S … Ask the individual to SMILE.
• T … Ask the person to TALK to SPEAK A SIMPLE SENTENCE (Coherently) (i.e., It is sunny out today)
• R … Ask him or her to RAISE BOTH ARMS.

NOTE: Another ’sign’ of a stroke is this: Ask the person to ’stick’ out their tongue. If the tongue is ‘crooked’, if it goes to one side or the other that is also an indication of a stroke. If he or she has trouble with ANY ONE of these tasks, call 911 immediately and describe the symptoms to the dispatcher!

Thank God for the sense to remember the “3″ steps, STR … Smile, Talk, Raise… Smile, Talk, Raise… Smile, Talk, Raise.

Take care,
Dean

The more research I do into so-called natural remedies, the more I run into one common denominator; placebo… placebo… placebo…

I wish it were not so. I wish I could report on scientific studies proving that the alternative treatments actually worked. But unfortunately, that is seldom the case.

Take for example, a recent blog post by Julianne Chickering entitled, Natural Remedies Are Not Inherently Sate, or Effective.

In her post she points to an article published in the July 24 issue of Archives of Internal Medicine, which reviewed no less then 70 studies of alternative therapies currently being used for the treatment of menopausal symptoms:

As more and more women and health care providers shy away from the traditional estrogen treatment because of its possible associated risks, complementary and alternative treatments are becoming increasingly popular.

She then points out that even though these treatments are becoming “popular” that doesn’t have anything to do with how they perform:

It turns out, however, that the efficacy of these treatments relies a great deal on whether or not you believe them to work.

Keep in mind as you read this that it is not nature that failed here. Nature didn’t make a mistake. Science didn’t make a mistake. It is the so-called “alternative treatments” being peddled as “natural” that always turn out to be hoaxes.

Anne Nedrow, M.D. and colleagues reviewed 70 previously completed studies of complementary and alternative therapies used to treat menopause-related symptoms. Their findings… showed that a strong placebo effect was about the only consistent result.

Chickering goes on to write:

Included in the techniques studied were herbal supplements, acupuncture, massage, visualization techniques, and listening to sonic waves. Some of the therapies resulted in an improvement over no treatment when women were asked to rate symptoms such as hot flash frequency, sleep disturbance, sexual dysfunction, and quality-of-life changes; however, often the improvement was almost equivalent to the improvement experienced by the placebo group.

I truly believe that nature holds the key to curing most, if not all, of the diseases that plague mankind.

Whether it’s something as simple as understanding the biomechanics of exercise or as complex as stem-cell research, the more we can learn from nature the better off we’re going to be.

At the same time, there is little question that we consumers need to be more cautious when it comes to choosing alternative therapies. We need to investigate these products thoroughly before putting them into our bodies.

There are far too many people who are just out to sell us something… whether it’s the drug companies, the health food industry or the various quacks that masquerade as healers. We can’t afford to trust something just because it happens to be popular.

Fortunately, the scientific community is doing research into these so-called natural remedies and providing us with a second opinion that we can consider before making a purchase.

Do your homework,
Dean

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Thanks.