Integration of Alternate Therapies into Mainstream Practice: Part I
To say that more people are going beyond the borders of scientific medicine in search of a cure for their ailments or simply to improve and rejuvenate their health is an understatement. One of my patients with chronic arthritis-related persistent pain despite treatment told me she is much better after acupuncture. Another older lady who had coronary bypass surgery twice and still experiencing frequent angina decided to go for chelation therapy only to return after a few weeks in a much worse situation. Some of the commonly asked questions by patients are, “Can I take herbal medicines? They are natural, right?” “Does garlic actually reduce cholesterol?” “I just don’t like drugs; can I try Chinese remedies? They are harmless, I presume,” etc.
There are a lot of people, who for one reason or other, are resorting to alternative therapies. It has now grown into a $35-40 billion industry. These nostrums include naturopathy, homoeopathy, acupuncture, Ayurvedic medicine, herbal therapy, yoga and meditation, Tai Chi, Zen meditation, Reiki, mega doses of vitamins, dietary supplements, including antioxidants and many more. All these are grouped under the term, ‘Complementary and Alternative Medicine’ (CAM), defined as medical approaches traditionally not addressed in allopathic or Western medicine. People are not necessarily disenchanted with conventional medicine, but they feel this would be complementary to their current regime and might enhance their health and well being. Also, the number of non-conventional healers advertising their products with wild claims of health benefits has steadily increased enticing more people to try these.
To explore the CAM practice in USA and subject it to the scrutiny of rigorous scientific methods, the United States government established a special center - the National Center for Complementary and Alternative Medicine (NCCAM) - at NIH in 1998. The center does proper research in CAM and disseminate authoritative information to the public and professionals alike. To assess how widespread the use of CAM is, AARP and NCCAM partnered on a telephone survey in 2010. Their key findings include:
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38 percent of U.S. adults (53 percent of people 50 and older) reported using CAM at some point in their lives.
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Herbal products or dietary supplements were the most commonly used.
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22 percent used massage therapy, chiropractic manipulation and other bodywork.
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Women, more than men, reported using any form of CAM, especially herbal products or dietary supplements.
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In most cases, the use of CAM increased with education.
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Relatively few respondents used mind/body practices such as meditation.
Taking these into consideration, there is an ongoing effort to integrate CAM into conventional medical practice. In India, many private institutions have added an Ayurvedic wing to their treatment facility, so physicians can use both modalities – best of both worlds, perhaps? There are now many centers for such ‘Integrative Medicine’ in the United States and most American medical schools are offering a course or two in it.
Many of these CAM modalities have been used for thousands of years in other countries. We all know the popularity of Ayurvedic Medicine in India that uses various herbal concoctions (kashayams), vegetarian diet, exercise, body massages with medicinal oil, meditation and prayers. Chinese medicine uses bioenergy manipulation or ‘qi’ (pronounced chi), acupuncture, special herbs, etc. Homoeopathy, osteopathy (manipulation of the bones and joints) and chelation therapy originated in the Western world. Native American Indians practice ‘Shamanism’ and spiritualism. There are many more therapies such as vitamin therapies, touch therapy, talk therapy, etc.
While it is true that there is an exponential increase in the enthusiasm of these therapies among the public, it is important to explore the scientific proof of their effectiveness. Humans are always so vulnerable, looking for magical cures for illnesses, often falling for appealing terms like ‘Holistic health practice,’ ‘Wellness revolution,’ ‘Nutritional supplements to boost your immunity,’ ‘Natural therapy,’ and so on. Some advertise “‘Bio identical hormone therapy’ designed to restore balance in women,” so they can feel rejuvenated. I don’t know if their claims can be properly validated. Some of these therapies may help your body, many have placebo effect, but there are several that can actually do harm to the body, including interaction with concomitant conventional therapies.
In the next few issues, I will try to cover some of the commonly used CAM therapies, their effectiveness and side effects. Like everything else in life, there is always ‘good’ and ‘bad’ about almost anything you do. Many of you who take these medicines may also know a lot more about CAM. If so, I would like you to share your experiences and opinions about these modalities.
To be continued . . .
Dr. M. P. Ravindra Nathan is a Brooksville cardiologist.
GUEST COLUMN
Can LASIK be Lasered Again?
LASIK eye surgery or Laser Assisted In-Situ Keratomileusis (LASIK) is one of the most common refractive eye surgical procedures in the world. With its ability to correct nearsightedness (Myopia), farsightedness (Hyperopia), Astigmatism and even after 40 reading glasses, millions of patients have been relieved of their glasses and contact lenses in a safe and predictable manner.
In the LASIK surgery, an Excimer laser at 193 nm is used to invisibly sculpt the cornea (front clear window of the eye) to correct vision errors in minutes.
This concept of sculpting the cornea with an Excimer laser lends itself into over 18 variations, i.e. Lasik with flap, without flaps, bladeless flaps, Laser PRK (surface ablation), Lasek (through superficial layer of cornea), EpiLasik, etc.
Also, given that Lasik surgery is performed on the cornea, it allows the cornea to become what I call a “Vision Rehabilitation Platform”. Thus, not only can the corneal surface be used to fine tune a corneal surgery (like Lasik) but also to combine with any intraocular surgery (surgery inside the eye like cataract surgery). Herein, lies the “secret” to correct practically any eye to perfect vision.
Going back to my previously published concepts of approaching every eye as a camera, let’s classify the reasons why you may need your Lasik corrected and you will see how the answer to your situation literally “unfolds in front of your very eyes.”
I have classified most LASIK surgery needing correction into the following categories:
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Incorrect Lasik surgery: The surgery did not reach its goal so you may be under corrected or over corrected.
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Regression of Lasik surgery: Despite a good outcome, your body reverses the error (minimally though)
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Aging changes over time irrespective of Lasik: Presbyopia (after 40 reading glasses), cataracts etc.
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Lasik complications or side effects: Haloes, glares, dry eyes, double vision, etc.
So, let’s review some of the most common presentations; In category 1, the surgeon can lift the same Lasik flap (in most cases, 3 months after previous surgery) and perform corrective laser surgery to reach the planned vision. In category 2, based on available tissue, the surgeon can lift the flap and perform additional laser or perform a surface ablation surgery like PRK on top of the Lasik flap. In category 3, the surgeon may be able to perform new Laser patterns to combine with previous Lasik (for example Monovision goal to correct recent onset presbyopia) or perform a totally unrelated surgery like cataract surgery and combine the two optics for the vision goal at this stage of Life. In category 4, the surgeon must first evaluate the cause of the complication/side effects and then address that with effective treatments, i.e., Lacrimal plugs for dry eyes, custom design Laser approach for glare or haloes or even reparative corneal surgery like minimally invasive corneal transplants.
From the above understanding, one thing becomes very clear: Lasik surgery is a serious surgery and can have serious implications on lifestyle for good or for bad. The key to successful patient outcomes is “Proper surgeon selection” and for the surgeon, “Proper surgery selection.”
So, do your due diligence and make sure your Lasik surgeon can perform the full range of Lasik surgeries including complication management and combination surgeries. Only then can they truly design the surgery in your best interest rather than “fit” the patient into the only surgery they know.
Be careful and do not fall for hyped-up Lasik advertising or deals. I always say, “Blindness at any deal is not a good Bargain!”
On a lighter note, most Lasik outcomes can be corrected with today’s technology and also combined with previous or future eye surgeries. For example, Lasik surgery can correct not only Lasik but also previous Radial Keratotomy (RK) and cataract surgery and in the same context, cataract surgery (as a Lasik patient ages) can be modified in patients who have had previous Lasik using new generation Lens implants.
Thus, not only can people today get rid of their glasses and contact lenses and see 20/20 but also expect to stay at that 20/20 vision throughout their lives.
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at [email protected] or visit www.gulanivision.com