• patientcare

    Acupuncture treatment for Interstitial Cystitis – any evidence?

    January 30, 2012 by · Leave a Comment

    After my last blog post I received numerous emails from numerous health care practitioners asking on the scientific evidence regarding acupuncture treatment of interstitial cystitis. Before I present this information, keep in mind that not everything that works can be proven - especially … [Read More...]

  • IC

    Interstitial Cystits – the other thorn in urology

    January 29, 2012 by · Leave a Comment

    If there's a condition that frustrates patients and physician's alike it's Interstitial Cystitis (IC). The emotional upheaval that IC patients go through is paramount. A big part of the problem is: 1. Few physician's understand this condition 2. IC patients are often misdiagnosed 3. … [Read More...]

  • joepa

    What killed Joe Pa?

    January 25, 2012 by · 6 Comments

    Today over 10,000 fans payed their respects to Joe Paterno, affectionately known as Joe Pa , the legendary football coach of Penn State. As a sports fan I am saddened by how the iconic coach had to give up his position as head coach of the team – a position he held for close to 50 years. As … [Read More...]

Jan
30

Acupuncture treatment for Interstitial Cystitis – any evidence?

By | ACUPUNCTURE, IC, Pelvic Pain

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After my last blog post I received numerous emails from numerous health care practitioners asking on the scientific evidence regarding acupuncture treatment of interstitial cystitis.

Before I present this information, keep in mind that not everything that works can be proven – especially therapies that are 5000 years old.  The importance of scientific investigation in all forms of medicine cannot be understated – we have made huge advances in medicine through science. However, for a practitioner to just depend on scientific data while working in the “trenches” trying improve our patients health is short sighted.

In the words of arguably the best scientist to ever live, ” Not everything that counts can be counted and not everything that can be counted counts.”  – Albert Einstein

A good doctor incorperates 3 things in their approach: science, clinical experience and the therapeutic relationship with the patient.

OK, I am jumping out of my soap box now.

Here’s the existing scientific data on acupuncture and interstitial cystitis (and associated conditions)

( I have taken this from other of my writings on the topic)

 

Patients with IC/PBS can potentially gain benefit from 10 to 20 sessions of acupuncture (Whitmore, 2002).  Alraek has been able to show in a study with 61 women that traditional Chinese medical (TCM) diagnosis can be useful in cystitis (Alraek et al. 2000).

In a study of 14 patients, Rapkin and Kames found that 6 to 8 weeks of acupuncture reduced the pain of IC (Rapkin and Kames, 1987).

One reported a case study of a 31-year-old woman whose IC symptoms were reduced with acupuncture to the kidney and bladder meridians (Lyons, 2001).

One Norwegian study of 67 adult women with a history of recurrent lower UTI were randomized into three groups in which one received acupuncture treatment, one had sham acupuncture, and one was given no treatment. A statistically significant 85% in the acupuncture group was free of cystitis during the 6-month observational period, as compared with 58% in the sham group and only 36% in the control group (Aune et al. 1998).

As you can see, the scientific data regarding acupuncture treatment for interstitial cystitis is limited at this time. Good randomized trials with the use of acupuncture are desperately needed for this patient population.

Keep posted as we are developing such studies at our institution at NYU.

 

Reference:

Whitmore KE. Complementary and alternative therapies as treatment alternatives for interstitial cystitis. Rev Urol. 2002;4(suppl 1):S28–S35.

Alraek T, Aune A, Baerheim A (2000) Traditional Chinese medicine syndromes in women with frequently recurring cystitis: frequencies of syndromes and symptoms. Complement Ther Med 8:260-265

Rapkin AJ, Kames LD. The pain management approach to chronic pelvic pain. J Reprod Med. 1987;32:323–3271.

Lyons P. Acupuncture treatment for interstitial cystitis: a case report. Am AcadMed Acupunct. 2001. http://www.medicalacupuncture.org.ezproxy.med.nyu.edu. Published 2001. Accessed November 1, 2007.

Aune A, Alraek T, LiHua H. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care 1998;16:37-39.

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Jan
29

Interstitial Cystits – the other thorn in urology

By | IC

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If there’s a condition that frustrates patients and physician’s alike it’s Interstitial Cystitis (IC). The emotional upheaval that IC patients go through is paramount.

A big part of the problem is:

1. Few physician’s understand this condition

2. IC patients are often misdiagnosed

3. There are no good, long-term helpful treatments

4. Very few physician’s want to treat this condition

5. There is little appreciation for alternative treatments that can be helpful

 

How do you know you have IC?

Generally, symptoms include:

  • Painful urination
    • Pain that is worsened with bladder filling and/or improved with urination.[8]
    • Pain that is worsened with a certain food or drink.
    • Some patients report dysuria (burning sensation in the urethra when urinating).
  • Urinary frequency (as often as every 10 minutes), urgency, and pressure in the bladder and/or pelvis.
  • Some patients report nocturia (waking at night to urinate), hesitancy (needing to wait for the stream to begin, often caused by pelvic floor dysfunction and tension), pain with sexual intercourse, and discomfort and difficulty driving, traveling or working.

 

The grand majority of IC sufferers are women but men with prostatitis have similar symptoms. Men can also have IC.

 

What’s the IC sufferer to do?

1. Find a physician that welcomes IC patients. Most urologist DO NOT want to see IC patients and you will know this soon after your meeting with him/her. Most IC welcoming physcian’s I know and have worked with are on the east coast – Dr. Robert Modwin, Dr. Philip Hanno, Dr. Elizabeth Kavaler and Dr. David Kaufman. This list is NOT complete by any means. For a wonderful resource around your area go to IC-network.

2. Just because a physician welcomes IC patients does not mean they have the answers that will cure you. IC, again, is often misdiagnosed and even when the correct diagnosis , curative treatment are often not available. Managing the condition will then become the goal.

3. Seek the help of a of a physical therapist that specializes in IC and pelvic pain. There is a complete list in ic-network.

4. Seek the help of a naturopathic physician and acupuncturist. Naturopathic doctors are trained to treat the cause of health problems. Often, to heal IC, the wise physician has to look outside the bladder and treat other co-morbidities like Irritable Bowel Syndrome (IBS). Naturopath’s and other nutritionally oriented physician’s can provide dietary help and dietary supplement guidance. IC-network can help you find a CAM practitioner too.

5. Get acupuncture treatments. This will almost definately help with the pain and discomfort and possibly alleviate urinary symptoms. To find an acupuncturist near you go to acufinder.com.

 

Bottom line

IC is often misdiagnosed. The symptoms may overlap with other disorders, including endometriosis, urinary tract infection (UTI), chronic pelvic pain, overactive bladder (OAB), and vulvodynia.

Although a cure can be challenging, relief of up to 80% is possible once you go to the right group of physcian’s. I know, I see this all the time.  If your condition is taking an emotional toll – seek a psychotherapist. Believe me, they can be extremely helpful.

Best of luck and DON’T GIVE UP.

 

 

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Jan
25

What killed Joe Pa?

By | Dr. Geo's take

6 Comments

Today over 10,000 fans payed their respects to Joe Paterno, affectionately known as Joe Pa , the legendary football coach of Penn State.

As a sports fan I am saddened by how the iconic coach had to give up his position as head coach of the team – a position he held for close to 50 years.

As a father of two, and soon three, I am irate of what happened and the fact that no one, including Joe Pa, and yes I am a fan, did not put maximal effort on protecting these kids from sexual abuse.

 

I have lots of opinions of what occurred at Penn State, but that’s not what this blog post is about.

More interesting to you are the questions: What killed Joe Pa? Was it lung cancer? Chemo?

 

The story of Dr. Bill Mitchell

 

Dr. Mitchell was a well-known naturopathic physician and one of the founders of the prestigious naturopathic school, Bastyr University. Dr. Mitchell was respected for his work in making naturopathic medicine scientific – as a result, he wrote several books on the topic.

In 2007, Dr. Mitchell’s 27 year-old son mysteriously died from a heart attack. Hours later, the beloved and respected Dr. Mitchell also died from a heart attack at the age of 59 – only hours later.

 

What killed Joe Pa?

 

On October 29th, Penn state football team beat Illinois on a game coach Paterno coached with just signs of aging at age 84.

On November 4th, former Penn State defensive coordinator Jerry Sandusky is indicted on 40 charges of sex crimes against boys. Some of those charges dated to Sandusky’s coaching days at Penn State.

On November 9th, Joe Pa is fired of head coach of the Penn State football team. A position he held for longer than most people that read this blog have lived.

On November 18th, just 11 days after his firing (give or take), the 84-year-old coach began chemo for lung cancer. The diagnosis was made a week earlier when Paterno visited his doctor for a bronchial illness.

In the Huffington post, a commentator states “ a broken heart did not kill Joe Paterno, cancer did.”

How do you know? You mean to tell me that he did not have lung cancer one-week prior? 6-weeks prior? Or even 6-months prior? Really?

 

Give me a break.

 

Cancer is a complicated disease and anyone who claims to know how it works is a moron. But cancer does not happen over night. And yes, it is biologically and scientifically feasible for “a broken heart” to expedite someone’s demise. And yes, un-managed stress, disappointment, depression, uncontrolled anxiety, loss of a loved one or sudden loss of a job that you passionately had can biologically cause a favorable environment for cancer cells to grow and progress.

 

The science of stress and cancer – overly simplified

 

There is a section in your brain called the hypothalamus-pituitary axis (HPA) that connects your hormonal system with your nervous system. Once an event or series of events is perceived as stressors, the nervous system sends a message to the HPA to start producing stress neuro-transmitters and hormones called catecholamine’s (epinephrine and norepinephrine) and corticosteroids (like cortisol) respectively – both being immune suppressive. There are hundreds of immune cells and immune mediators that are suppressed by chemicals produced by stress including Natural Killer (NK) cells. NK cells (among others) are notorious for defending the body against cancer cells. Optimizing the activity of these cells is a good idea. (Reiche et al. 2004)

 

Bottom line

 

Joe Pa lost his passion, his love and perhaps most importantly, his identity when he lost his job as head football coach of Penn State. So much so that he turned down several NFL coaching jobs during his career. He even failed to report the nauseating actions of his staff member to protect the name of the school and team.

So what killed Joe Pa? I don’t know for sure but a broken heart was indeed a major contributor.

 

Reference:

 

Reiche EM, Nunes SO, Morimoto HK. Stress, depression, the immune system, and cancer. Lancet Oncol. 2004 Oct;5(10):617-25.

 

 

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Jan
23

Prostate Cancer: 10 Evidence Based Naturopathic Tips

By | PROSTATE CANCER

1 Comment

 

One of the things that really bother me is when patients come to my office and tell me that their physician said there is no evidence for naturopathic approaches to prostate cancer.  Last Friday, I had a patient come in and say just that. Ahhrrr! At minimum the naysayers can say ” I am not aware of the evidence” or admit that they simply have very little knowledge on this topic -  I have much respect for those physician’s that do.

On this blog post I present a dearth of evidence-based information on slowing or possibly reversing prostate cancer progression with natural lifestyle practices – there are thousands of scientific articles on this. Feel free to print this and bring it to your physician’s office – beware, if he/she is stubbornly cynical it may stay unread.

 

10 quick evidence-based naturopathic tips to combat prostate cancer

 

1. Limit your meat intake and do not eat well-done, charred or overcooked meats. Overcooked, well-done meats form a compound called heterocyclic amines (HCA). There is now increasing evidence that HCAs found in cooked meat are crucial carcinogens that have been implicated in the development of several human cancers (Zheng W et al. 2009)

 

2. Limit your consumption of simple carbohydrates. Food sources rich in simple carbohydrates include table sugar, corn syrup, white bread, white pasta, fizzy drinks and cakes.  Complex carbohydrates can be found in whole grains such as brown rice, buckwheat and sweet potato. Over consumption of simple carbohydrates may cause hyper-insulinemia and obesity, which has been postulated to increase the risk of developing prostate cancer (Pollak et al. 2004).

3. Eat more fish. Oily fish such as mackerel, sardine, salmon and trout are an excellent source of omega-3 Poly Unsaturated Fatty Acids (PUFA). A few large observational studies have suggested a beneficial association between high fish or omega 3 PUFA consumption and reduced risk of developing prostate cancer (Leitzmann et al. 2004).

 

4. If you are overweight, lose weight. There is evidence suggesting that men who are overweight have higher chance of developing advanced prostate cancer, higher risk of dying of prostate cancer, and progression after prostatectomy. (Rodriguez et al., 2009)

 

5. Eat a plant-based diet emphasizing cruciferous vegetables. Cruciferous vegetables are part of the Brassicaceae family, which includes horseradish, broccoli, cabbage, brussels sprout, cauliflower, bok choy and wasabi. The active ingredient in cruciferous vegetable is a compound called isothiocyanates (a metabolic derivative of glucosinolates) has been shown to have potent anticancer properties (Yang et al. 1994). Several epidemiological studies have previously reported a reduced incidence of prostate cancer amongst men who have a high consumption of cruciferous vegetables (Krystal et al. 2002).

 

6. Drink several cups of green tea a day. Green tea, derived from the plant Camellia sinensis, contains polyphenolic compounds, most notably epigallocatechin-3-gallate (EGCG), an antioxidant that is 25–100 times more potent than Vitamin C and E. A large prospective cohort study of 49,920 men and their green tea consumption habits those who consumed 5 cups or more a day were at lower risk of advanced prostate cancer (Kurahashi et al. 2008).

 

7. Use dietary supplements intelligently and seek professional guidance if possible. While some supplements can be safe and protective in moderate amounts others can be harmful in people consuming higher dosages. This is the case for zinc, beta-carotene, vitamin E (alpha-tocopherol) and folic acid (Schultz et al. 2011)

 

8. Supplement with 1000 to 2000 units of vitamin D. Vitamin D is believed to be important in the protection of human prostate cells (Peehl et al. 2003)). Epidemiological studies indicate that sunlight exposure is inversely proportional to prostate cancer mortality and that prostate cancer risk is greater in men with lower levels of vitamin D (Studzinsky et al. 1995). Higher dosages (up to 5000 units or more may be needed in some people.)

 

9. Take 50 units of vitamin E ( alpha tocopherol) in a formula that includes gamma-tocopherol – make sure the label reads mixed tocopherol on the back. One study demonstrates the possible protective effect of alpha-tocopherol vitamin E among males taking 50 units a day (Heinonen et al. 1998) while another showed an INCREASE in prostate cancer among men taking 400  units (8 times as much) of alpha-tocopherol vitamin E (Klein et al. 2011). Perhaps more importantly, other vitamin E components found in nature like gamma-tocopherol is likely to be even more protective when combined with alpha-tocopherol (Helzlsouer et al. 2000)

 

10. Exercise 3 to 4 times a week and combine weight resistance with aerobic exercises. The current data suggest that clinical exercise in patients with prostate cancer improves fatigue, muscle strength, aerobic fitness, flexibility, quality of life, body constitution, blood lipids, and well-being. These positive effects in patients with prostate cancer were observed with regard to resistance and endurance training programs (Baumann et al. 2012)

 

References:

Frattaroli J, Weidner G, Dnistrian AM, Kemp C, Daubenmier JJ, Marlin RO, Crutchfield L, Yglecias L, Carroll PR, Ornish D. Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology. 2008 Dec;72(6):1319-23. 2008 Jul 7.

Zheng W, Lee SA. Well-done meat intake, heterocyclic amine exposure, and cancer risk. Nutr Cancer 2009; 61: 437–46

Pollak MN, Schernhammer ES, Hankinson SE. Insulin-like growth factors and neoplasia. Nat Rev Cancer 2004; 4: 505–18

Leitzmann MF, Stampfer MJ, Michaud DS et al. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer. Am J Clin Nutr 2004; 80: 204–16

Rodriguez C, Patel AV, Calle EE, Jacobs EJ, Chao A, Thun MJ. Body mass index, height, and prostate cancer mortality in two large cohorts of adult men Sep o Oct 2009 in the United States. Cancer Epidemiol Biomarkers Prev. 2001;10:345-353.

Yang CS, Smith TJ, Hong JY. Cytochrome P-450 enzymes as targets for chemoprevention against chemical carcinogenesis and toxicity: opportunities and limitations. Cancer Res 1994; 54 (Suppl.): 1982s–1986s

Kristal AR, Lampe JW. Brassica vegetables and prostate cancer risk: a review of the epidemiological evidence. Nutr Cancer 2002; 42: 1–9

Yang CS, Smith TJ, Hong JY. Cytochrome P-450 enzymes as targets for chemoprevention against chemical carcinogenesis and toxicity: opportunities and limitations. Cancer Res 1994; 54 (Suppl.): 1982s–1986s

Kristal AR, Lampe JW. Brassica vegetables and prostate cancer risk: a review of the epidemiological evidence. Nutr Cancer 2002; 42: 1–9

Kurahashi N, Sasazuki S, Iwasaki M, Inoue M, Tsugane S. Green tea consumption and prostate cancer risk in Japanese men: a prospective study. Am J Epidemiol 2008; 167: 71–7

Peehl, D.M., Krishnan, A.V., & Feldman, D. (2003). Pathways mediating the growth-inhibitory actions of vitamin D in prostate cancer.

Studzinski, G.P., & Moore, D.C. (1995). Sunlight–can it prevent as well as cause cancer? Cancer Research, 55(18), 4014-4022.

Heinonen OP, Albanes D, Virtamo J, Taylor PR, Huttunen JK, Hartman AM, et al. Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial. J Natl Cancer Inst. Mar 18 1998;90(6):440-6.

Klein et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011 Oct 12;306(14):1549-56.

Helzlsouer, K.J., Huang, H.Y., Alberg, A.J., Hoffman, S., Burke, A., & Norkus, E.P., et al. (2000). Association between alpha-tocopherol, gamma-tocopherol, selenium, and subsequent prostate cancer. Journal of National Cancer Institute, 92(24), 2018-2023

Baumann FT, Zopf EM, Bloch W.Clinical exercise interventions in prostate cancer patients-a systematic review of randomized controlled trials. Support Care Cancer. 2012 Feb;20(2):221-33.

 

 

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