In this post i write about two unforgettable patients. The first one was a patient in his forties a smoker with diabetes, hypertension and hyper-lipidemia. He went on to develop exertional angina. His electrocardiogram showed ischemia at rest and an echocardiogram revealed regional wall motion abnormalities in the areas corresponding to the ischemia. He was started on nitrates in addition to aspirin he was already on. He was not willing for angiogram or any other procedures. His angina worsened to a stage where he was hardly able to walk for five minutes before getting angina. The nitrates had been increased to the maximum and calcium channel blocker and beta-blockers had been added without much use. i expected him to go for infarction any day. He asked me whether there was any other medications for relieving his chest pain.When i said there was none, he went for alternative treatment (Unani). He came after a few days and told me, that he was pain free and had stopped all the nitrates. I was happy for him but still expected him to be brought with infarction one day. He continues to smoke, has stopped all medications other than his anti-diabetics, including aspirin and is pain free. Not only that, his sugars are normal with nearly half the medications he had been prescribed. It is nearly five years now.This was one patient who brought me, belief in alternative medication. Each time i see him, i am surprised at what true alternative medicines can do. In this era of science and evidence medicine, it made me believe there are many things which can be learn from true practioners of alternative treatments.It also made me believe absence of evidence does not mean lack of evidence.
The second patient is a patient again a non-hypertensive, poorly-controlled diabetic, who came with three hours history of difficulty in speaking. On examination he had evidence of lower cranial nerve paresis (7, 9 & 10) with recurrent aspiration and dysarthria. He could not afford an CT of the brain at admission.So i started him on aspirin. He recovered dramatically and within eight hours he was totally asymptomatic. At this time the attendees were willing for a CT. The CT revealed a cortical infarct on the opposite side. So what he probably he had was a brain stem TIA with a old asymptomatic cortical infarct. He was taken against medical advice after the CT for alternative treatment.I was surprised. Usually patients go for these when the treatment they are taking fails, not when it is improving dramatically. I have found, for strokes these patients get nothing but a good physiotherapy.The problem is they stop the secondary prophylaxis and invariably end-up in recurrent stroke.This patient has not come back to me but i have seen many patients with ischemic strokes on alternative therapy going for recurrent stroke without aspirin prophylaxis.
So what is the conclusion. There are areas where alternative therapies hold big promises. There are areas where they fail miserably. The failure may be because of people who do not know these therapies practicing the art (Probably the main cause. You can get a degree in any of the alternative therapies by distant education in six months flat!) or because there is no real treatment in that system.It is our duty to find evidence for therapies where it seems to be obviously successful. Once we have positive evidence, more people will search for evidence and the ultimate benefit is of course to the patients of these chronic diseases.
The second patient is a patient again a non-hypertensive, poorly-controlled diabetic, who came with three hours history of difficulty in speaking. On examination he had evidence of lower cranial nerve paresis (7, 9 & 10) with recurrent aspiration and dysarthria. He could not afford an CT of the brain at admission.So i started him on aspirin. He recovered dramatically and within eight hours he was totally asymptomatic. At this time the attendees were willing for a CT. The CT revealed a cortical infarct on the opposite side. So what he probably he had was a brain stem TIA with a old asymptomatic cortical infarct. He was taken against medical advice after the CT for alternative treatment.I was surprised. Usually patients go for these when the treatment they are taking fails, not when it is improving dramatically. I have found, for strokes these patients get nothing but a good physiotherapy.The problem is they stop the secondary prophylaxis and invariably end-up in recurrent stroke.This patient has not come back to me but i have seen many patients with ischemic strokes on alternative therapy going for recurrent stroke without aspirin prophylaxis.
So what is the conclusion. There are areas where alternative therapies hold big promises. There are areas where they fail miserably. The failure may be because of people who do not know these therapies practicing the art (Probably the main cause. You can get a degree in any of the alternative therapies by distant education in six months flat!) or because there is no real treatment in that system.It is our duty to find evidence for therapies where it seems to be obviously successful. Once we have positive evidence, more people will search for evidence and the ultimate benefit is of course to the patients of these chronic diseases.
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STDoc, I personally do not believe in the efficacy of alternative medicine, but I do believe that we don’t understand everything our mind is capable of.
I believe that there are some people who can actually alter their physiology with their minds. It may not be deliberate, and it’s most likely not even a conscious action, but rather, it’s a tapping into things that we don’t currently understand.
Why can’t everyone do it? I have no idea, any more than I know why anyone can do it.
In short, I believe that this the only power most alternative medicine wields – fooling the mind into believing that they’ve done some good.
I beg to differ from you Moof. I believe there are lots of real stuff in alternative medicine. People who practice without the proper knowledge are tarnishing its image and efficacy. For so many medicines have been reverse engineered from these alternative medicines only. Examples are Digoxin, Quinine and so many extracts of plant medicine. Though people who discovered it, did not know its exact chemistry, they knew where to use it and used it with good effect over generations. Once you know it works, you can always try theories till it fits and give a scientific explanation. It is like these, because i do not know how the cell phone electronics works, does not mean i do not know how to operate my cell phone. So i believe there are lots of real things in alternative medicine other than placebo effect also.
Is Unani a specific alternative treatment, or just the word for all alternative treatments. Any additional information on just what sort of treatment this patient received?
I am always open to my patients seeking answers outside of traditional medicine, but like you, I worry that they may stop those things in my realm of treatment that may benefit them. I’ve been quite impressed with acupuncture treatments I’ve received, but I do find homeopathy a very hard concept to embrace.
I have a deep mistrust of alternative medicine. I’d say it’s okay for chronic ailments, but it’s absurd to go to a say, homoeopathic doctor, for something like a CVA. A lot of alt docs I’ve met talk nonsense, like honey is GOOD for diabetes, stuff like that. I just nod and smile when they say that, while gritting my teeth to dust.
Miss you, doc.
A four month old reply to Denver doc. First of all i apologise for this delayed reply to your comment. Second the reply – Unani, is not a word for all alternative medicines but to a specific field of non-allopathic medicine where disease state is considered to be an imbalance of the four basic essence of a human body – phlegm, blood, yellow and black biles. With Arabic roots, this tries to restore this fine balance. They have courses in Unani in India, five and half years long culminating in a Bachelor’s degree. My personal belief is more than people learning from these courses, the traditional practitioners with practices being handed down multiple generations, are more knowledgeable and successful in their treatments.