Tuesday, December 15, 2009

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.


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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Friday, December 11, 2009

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