Overuse of CT scans will lead to new cancer deaths, a study shows -- latimes.com

I just read this article in the Los Angeles Times and wanted to share with my readers.

Overuse of CT scans will lead to new cancer deaths, a study shows -- latimes.com

The overuse of CT scans, like the overprescription of antibiotics, is I believe emblematic of a medical system that is under increasing pressure to perform, and perform fast and effectively, with less and less infrastructure to support the healthcare providers to provide the best care to their patients. HMOs are requiring doctors to see more and more patients an hour, cutting down the quality time both doctors and patients want to give and receive. Patients want results right away. Doctors want results right away. Insurance companies want patients in and out of hospitals as quickly as possible yet be making lucrative money.

It is also the scare - the fear - that patients have. As the article says, many patients get the CT scans, even if they seem perfectly healthy, because they are afraid of some lurking tumor or disease in them. And it really is the irony that by exposing themselves to these unnecessary levels of radiation that may ultimate cause the cancer they were hoping to prevent.

While our healthcare system is currently going through major upheavals, the one thing patients have in their control is to be completely aware and educated about every test and procedure that are going to be done to them and for what reason. If it's invasive, find possible less invasive or non-invasive alternatives. I believe the more educated, empowered and in control patients are of their health and healthcare, the better they can prevent diseases, and should they need to receive medical services, that it would allow them optimal, effective healthcare.

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My experience in the Dominican Republic - 4

(To read Parts 1, 2, and 3 of this trip, click here)

Day 6 - YASICA

This location was the farthest we would go from our hotel, about a 50 minute ride up into the mountains, passing Camú. As became the case in every location we visited, I saw mostly adults and senior citizens, but because our mission today was inside a school, I had more school-aged children and teenagers. It was great, they all came in still with their uniforms during what I imagine was their class times.

(Simon, John the photographer and Tomoko, prepared to face the rain to walk back to the school after our lunch break.) This was also the very first day that we had rain while in DR. And rain it rained! As the day progressed, the clouds started to take cover, and all of a sudden, around 1pm, we started getting pouring thunderous rain. It rained for a good hour or so. It then stopped completely. Typical tropical storm, I was told. Later in the evening, it started to rain again, and the rain came down pouring by the time we arrived to the hotel.

We got to enjoy fresh sugar cane! Delicioso!

Dusk before the next thunderstorm

By the way, acupuncture is not known in Puerto Plata, the third largest city in DR, so it was the first time for every patient to get acupuncture from me. (Acupuncture is known in other parts of DR. For example, in Santiago, the second largest city in DR, and from where Omar and Mirla the sibling assistants are from, acupuncture is very well known.) Even though they had never had acup. before, most Dominicans who were complaining of some sort of pain in their body (headache, back ache, knee pain, shoulder pain, etc), colds, allergies, fatigue, high blood pressure, anemia, and/or diabetes readily agreed to be treated by me.

The wise and experienced crewmember, Jae, who was our traffic controller of patients within the medical dept, always directed any patient whose registration form indicated any of the aforementioned conditions and complaints. Sure, some patients were afraid and nervous, asking the ubiquitous question, “Do the needles hurt?,” but for the most part, most patients just let me treat them without any questions. There were surprisingly very few people who flat out rejected my treatments. Once they started feeling their pains going away with my treatment, they were impressed and quietly sat in their chairs for about 20 minutes. Not that it was quiet. There was always a long line of people as well as children and infants waiting inside and outside to be treated by us three doctors, and curious people just watching, so there was always a lot of chaos and noise and people milling around. Jae and the other aides were always trying to keep order and some semblance of peace in our stations.

Because I know my students and fellow acupuncturists are reading this, I want to write a little more on the clinical aspect of what I saw. So I will write this part primarily addressed to this group, making the following few paragraphs layreader-unfriendly. I apologize in advance.

As I wrote earlier, the bulk of the conditions I treated were fatigue, pain, allergies, colds, anemia, diabetes, and high blood pressure. From a TCM perspective, there was a lot of Bi syndrome, Spleen Qi xu + Damp, and Qi and Blood xu conditions.

Of the hundreds and hundreds of patients that I saw, I can literally count, in my fingers, maybe 4 or 5 patients who had wiry, forceful, strong pulses. Most of the patients had slippery but thin, feeble, weak, deep pulses. Some rapid, but mostly not. This was a big difference from many of the patients I treat privately. Most of my private patients have excess pulses, often wiry or surging and rapid. The majority of the tongues I observed in DR were wide, flabby, scalloped, pale with slight or significant yellow coating. Very few thin, red, yin xu tongues or dusky or red stagnation/excess heat tongues. Physically, most were overweight, though there was a fare share of healthy weight individuals. (There was one young, slender mother who came in complaining of how she had no appetite. She looked at me and said “See, look how skinny I am!” in a complaining tone. If you saw this same woman here in Los Angeles, everyone would be envious of how skinny she was! Hearing her complaint was such a refreshing change!)

So, without being able to do a full intake or even a 15-minute consultation which is the minimum I’d do with my private first-consult patients, based just on the tongue and pulse, I can say from this experience that the majority of underprivileged Dominicans I treated suffer from deficient conditions most likely due to their suboptimal diet. Weather plays a key role here as well, with constant hot tropical weather (i.e. high humidity/rain fall) engendering mass damp-bi conditions.

In terms of needling, I used no more than 10 needles, making it easy to track how many I was using per patient. I combined primarily the 5 transporting points, Master Tung points, and ear points. If I was treating only pain, I often needed only 2 or 3 points, and to that I might have added couple supporting points to address the root of the problem, but often times just those 2 or 3 points were all that was needed to significantly reduce the pain or resolve it all together. It was fascinating to watch how quickly the treatments took effect.

Day 7 - CANTABRIA

What with all that work, heat, and sweating, it finally all got to me. By Day 7, I was so exhausted, I could barely eat breakfast nor sit up. My back was starting to give out. I knew if I didn’t rest that morning, I wouldn’t be able to make it on the flight the next morning to Los Angeles, so I decided to rest-in that morning. I felt guilty letting my teammates down, but I’m glad I did so nonetheless. I slept an extra couple hours and that helped tremendously, b/c by the time the crew came back to eat lunch at the hotel, I was feeling a lot better, ate lunch with them, and joined them in the afternoon medical mission. But acupuncture was not to be given.

It turned out that the location did not have enough space for me to set up my acupuncture station, so I ended up helping to translate for Dr. Karen, as she spoke no Spanish. It worked to my advantage, as I was able to stay seated the whole afternoon, which helped to prevent my back from getting worse. If I had to do my acupuncture treatments, there would’ve been a lot of sitting, getting up, bending over and moving from patient to patient, which would’ve definitely regressed my weak back to a worse state.

My vantage point as I helped Dr. Karen with translation

OK taking a breather from her pharmacist duties

Dr. Tomoko palpating a patient

This community was different from the other 4 communities we treated in that there was a significant number of Haitians residing there. Because of the dire economic state in Haiti, many Haitians emigrate next door to DR to try and eek out a living. Their native language is Creole and French. As a result, often through the consultation that day, we'd have a Haitian translator who spoke Creole and Spanish who would translate for the Creole-only speaking Haitian, and then I'd translate the Spanish to English for Dr. Karen. Three languages going on at one time was fascinating to watch.

I heard from Omar and Mirla that there is a lot of discrimination from Dominicans against Haitians, but in this community, from what I could observe, people seemed to coexist respectfully and harmoniously.

In addition to the usual ministry work and handing out of photographs, we finished our last mission that night by providing free sandwiches and drinks to all the community members. We hired a local lady to make the sandwiches and punch. She made over 300 sandwiches and they went fast!

DAY 8 - LAST DAY

On our last day, we had the morning off, so couple of us crew members went to the beach to read, swim and relax. It was a beautiful morning. After finishing lunch, we convened with all of our luggage at the hotel lobby, and like when we came 8 days ago, Pastor Aaron and Omar helped put all of the luggage back on our Little Truck That Could and took us back to the airport. As happy as I was to go back home because I was exhausted, I definitely got wistful realizing that this intense experience and the resulting comraderie that came about with everyone was slowly coming to an end.

The beautiful beach the morning of our departure

The Little Truck That Could. We were always packed to the rim wherever we travelled in this truck.

Dr. Lee goofing off, "I'll be back!" a la Terminator

The local crew members

I met really nice local people, young men and women willing to help and always ready with a smile. Dominicans are very hard working. They are also a deeply religious people, and like in most latin countries, their faith keeps them going through all obstacles. It was inspiring to watch this, realizing they have so much less than most of us (at least the majority who's reading my blog), and yet they keep their chin up, smile and don't complain much. When one has less, one really doesn't take things for granted.

I am really happy I was able to experience this. I made new friends both in the DR and with the Korean church crew. Having experienced what I experienced, I'd like to begin volunteering my services in Los Angeles helping the underserved community. Now that I know I can see 100 patients a day and know how to set up the logistics, it’s easy peasy Japanesey! ☺ Instead of going far and getting exhausted from an intense mission trip, I can just look in my backyard and help people in need.

I’d like to give a special shout out here to Torrance First Presbyterian Church for organizing and funding this mission, as well as to K.S. Choi (GoAcuzone.com) for providing the acupuncture supplies at a discount to the mission. I know there were also several people at the church who did all the behind-the-scenes planning that made this mission possible. I’d also like to thank Pastor Aaron, Omar and Mirla for taking such good care of us and working so hard to bring basic medical and dental care to hundreds of needy Dominicans. I'd like to give another special shout out to Laraine Crampton, L.Ac., for being such an invaluable resource and help in preparing me for the trip. And lastly, I’d like to thank the 10 crew members for letting me come on board this mission and giving me the opportunity of a lifetime.

Our "official" portrait

My experience in the Dominican Republic - 3

(To read Part 1 & 2 of this journey, click here.)

Day 4 - CAMU

On this day, we visited Camú, an area inland, with small houses dotted along a single mountainous road. It was about a 30-minute ride from the hotel. Like in Playa Oeste, initially there were very few people waiting, but within 20 minutes or so, there was a crowd of people eagerly waiting to receive free medical care from us.

We all quickly went about setting up our designated stations. Having devised a new set-up for the acupuncture station, I was armed and ready to treat another 100 patients today! My station was the first to be set up, as would always be the case the rest of the week -- in about 10 minutes -- because all I needed were a few chairs, a table, my needles, sharps container, alcohol swabs and cotton. General medicine - and our newcomers, the Dental team - would take about 30 minutes because of the slew of drugs (for the pharmacy) and tools and equipment required (for dentistry). The paraphanelia required to do dental work was mind boggling. Thank goodness these two departments had extra local assistants helping.

In terms of doing acupuncture, I can now see why acupuncturists were called Barefoot Doctors in China and why this medicine grew out of China, a country with a population of well over 1 billion. Once armed with the proper training, all an acupuncturist fundamentally needs are needles. (Plus of course the sharps container, cotton, and alcohol swabs for safety and sanitary reason.) Just with needles, we can effectively treat a multitude of people and conditions. Imagine had I brought my other tools found in Traditional Chinese Medicine, such as moxa, cups, e-stim, and herbs, the greater degree of relief I could've provided the Dominicans!

The acupuncture station before the chaos

Dental tools

Local assistants Stephanie, Amelfi, and two Korean national assistants, Penelope and Eunju

Other scenes from Camú:

Tragedy had befallen this woman, and our staff was praying for her.

(This little girl was so cute. All through this consultation, she sat on her mother's? grandmother's? lap, quietly, sucking her pacifier, intently watching every move that Dr. Tomoko made.)

(This little boy was also adorable. While his mother got treated with acupuncture, the boy sat quietly the whole time next to his sister, and was constantly mindful of having his hand on his mother's body. He would get distracted by all the commotion, and then realize that his hand wasn't touching his mother, and would quickly go back to touching her belly or arm, or somewhere, as long as he was touching his mother.)

I don’t know which was more tiring – the huge numbers of people I was treating, or the heat and humidity without any air-conditioning. I had constant trickles of sweat dripping down my face, neck and back every day. I was basically bathing myself in my own sweat every day. By the second day of doing these intense medical missions, I got a heat rash on my abdomen. It was so darn hot and humid!! (But I came back with beautiful, supple skin from all that moisture! LOL!) Mirla and the other aides had to frequently change the wet, cold towel around my neck to try and keep me cool.

I couldn't live without these towels!

Day 5 - LOS RIELES DE SAN MARCOS

This was another location about 20 minutes from the hotel. We conducted our work inside a local church. Acupuncture was stationed up by what I suppose was the altar as it was elevated from the rest. Boy was it hot in there. We had fans going, but it was just blowing the hot air over and over. At one point, the electricity went dead because so much electricity was being used by the dental department, haircutting department, fans and printer. Thank goodness for our reliable generator, which allowed Dr. Lee the dentist to keep working!

Scenes from San Marcos:

That's the acupuncture station, in the back. Dentistry to the left, and general medicine to the right.

I think the recirculating hot, humid air plus being elevated from others (making the air even hotter) got to me that day because I started to get dizzy part way through my morning stint. I had to stop about 2 hours into it. I had to step outside and rest in our little truck for a while until I could feel normal again. After a good lunch, I was thankfully back to working.

Patients resting as they got their acupuncture treatment.

This family (the girl on the left was a friend) was so adorable. The mother was very shy and soft spoken but very sweet and loving to her daughters. The children were very well behaved all throughout the day. Later in the evening, while Christian work was going on, the little girl in the light blue dress was meandering around the crowd and came upon Assistant Eunju and I. When we asked her for a kiss, she readily and without hesitation came up to us and planted both of us a cute, sweet kiss on our cheeks!! I just melted there! All the hard work was so worth this little kiss :-)

Pharmacy busily dispensing medication

Dr Karen trying to cool off

These boys were great, always eager to talk to us in their limited English. They came up to me to say hello in English, and introduced themselves. I introduced myself, but realized one English etiquette was missing in our dialogue: I taught them to say "Nice to meet you" which is "un placer conocerte" in Spanish. When they learned what "nice to meet you" meant, they scurried back to the other English staff they had introduced themselves to earlier and finished their introductions properly. Later in the evening, couple of the boys came back to ask me again how to say "un placer conocerte" in English. When we were leaving for the night, the boy in the black pants came by our truck and thanked me in Spanish for the English lesson and our work. Again, all the hard work was so worth it with these kinds of exchanges.

Doc, how does my new teeth look?

Children doing song and dance along to the Christian missionary work

This day was also John the photographer's birthday. We were able to celebrate with cake and serenading. Fun times.

The last of these chronicles coming real soon...

My experience in the Dominican Republic - 2

(To read Part 1 of this journey, click here.)

Before I continue with the rest of my week-long experience, the following is a quick overview of what became our daily schedule:

Our days started early. 7:00am breakfast call (the Koreans had bible study at 6:30am!), loaded and ready to go on our little truck by 8:30am-9:00am, and to our location by 9-9:30am. Except for Sunday, which was a day off b/c the crew went to church, everyday from Saturday to Thursday we worked from about 10am to about 6:30pm, with about a 1-hour lunch break in between. From 6:30 to about 8pm we had set down, packing and Pastor Aaron and his assistant Omar would share their Christian faith with the people we treated earlier in the day with songs, puppet show and slide shows. We’d then head back to the hotel and have dinner around 8:30pm, and I tried to be in bed and sleeping by 10:30pm every night. I had a hard time sleeping the first few nights from all the excitement and nerves but by the third night both from exhaustion and getting the swing of things, I was in a routine and sleeping pretty much through the night.


Day 2 - PLAYA OESTE
Oh talk about being nervous and excited! I could barely eat my breakfast that morning, as it was going to be my very first of 5 medical visits to the surrounding neighborhoods in the week to come. I knew to expect a huge line of people and chaos, but I still didn’t really know what to expect, so my poor stomach was all in knots.

We arrived to Playa Oeste, an area about 20 minutes from the hotel. We were to be housed in a small 4-room school. There weren’t too many people when we first arrived, which surprised me, but it let me sigh a sigh of relief. I jumped the gun, though. After about 30 minutes, there was all of a sudden a long line of people waiting outside! The school became quickly filled with Dominicans eagerly waiting for our services. General medicine and I (acupuncture) quickly set up our stations, and after people went through registration, having their name, age, blood pressure and chief complaints recorded, they were directed to the appropriate departments.

I was given the wonderful support of a daily local assistant, hard working and sweet Mirla, who helped with removing needles and keeping the flow of patients coming and going. I asked her to keep a tally of how many patients I was seeing, and according to her records, I saw 93 on this day! (And as the days went on, I was averaging about 100 patients a day.) Holy cow, I didn’t think I had it in me! Thank god for my energy bars and protein shakes I brought from home. They helped so much in between meals. As the days progressed, I remembered to take frequent short breaks, drink tons of water (with electrolytes in it), take my herbs, and pace myself, too.

That's my awesome assistant, Mirla

People waiting in line to get acupuncture

As part of our mission, the crew had also brought a supply of canes for the visually-impaired. The president and vice president (I believe) of the local blind organization came to the school that day to receive the supply from us. Both general medicine and I were able to provide care for them as well for their non-vision related health concerns. At the end of our day, before we headed back to the hotel, the crew formally presented the two representatives with the supply of canes. It was gratifying to hear that these canes would help the visually-impaired to gain a little more independence, as those with handicaps in the DR are not yet given much social or governmental support.

Pastor Aaron and Mirla speaking to the two visually-impaired representatives

I learned a lot from my day at Playa Oeste. First and foremost: Pace Yourself! That day, I had about 5 patients at a time sitting in chairs, randomly placed in the room, and I would go from patient to patient, taking a quick look at their registration form, asking them couple questions, then taking their pulse and looking at their tongue to make a quick diagnosis. I would then begin inserting the needles in the limbs and ears of the patients, requiring me to bend over, kneel down, get up and overall get a real work out on my back and knees. I quickly realized this would not help me last for the next 6 days.

Later on during dinner, I mentioned this fact to Jae, and ever the smart woman that she is, she came up with the brilliant idea of having a 4-patient acupuncture station with patients sitting, with their legs up on chairs, all side by side. In between patients, we were to put single chairs so that I could sit between patients and do my care by just turning around in my chair. This allowed minimal getting up and out of chairs by me as well as not having to get on my knees. This was to help me tremendously in the days to come. ...And of course, the frequent snack, water, and breather breaks.

DAY 3 - DAY OFF

Because this was Sunday, we were given the day off. The Koreans went to church in the morning, I slept in, had breakfast and hung out by the beach with my friend Tomoko until it was time for lunch. We all joined together for lunch, then went on a little excursion of Puerto Plata.

Pastor Aaron and Omar took us on a furnicular ride up one of the highest peaks in Puerto Plata to enjoy the wonderful panoramic view of this beach town. DR is so lush and verdant! And it was so cool up at the peak. There was a nice botanical garden we could meander through. There was also a little bit of Rio de Janeiro going on up there, too, with a huge Jesus Christ statue.

Puerto Plata

One of the rare group shots

Rio in Puerto Plata

After the furnicular ride, we went to a local supermarket to purchase water for the next several days. We also indulged in refreshing sherbets made with local fruits.

Being tropical, there was an abundance of fruits in DR, here frozen to make a sherbet.

This was also the day that the husband-and-wife team, Drs. Lee and Karen, and the dental assistant John arrived from Los Angeles.

I ended the evening with a nice stroll on the beach, before heading to the hotel restaurant for dinner. This would be the last time I would see this beautiful beach sunset b/c after this, every night, we were too busy, away on site, or tired to stroll for a leisurely walk.

To read Part 3, click here