Is it Hot in Here or is it Just Me? Acupuncture, a Safe, Effective Approach to Menopause.

This month’s article will discuss the conventional and Traditional Chinese Medicine (TCM) approach to menopause.

Is it Hot in Here or is it Just Me? Acupuncture, a Safe, Effective Approach to Menopause., Hoku Integrated Healthcare in Westshore Colwood, Victoria BC

It is September, and the kids are back in school.  Now that the summer holidays are over, it is time to focus more on our health. Fall, the Metal element in TCM, is a time for letting new ideas into our lives and letting go of what does not serve us.  Soon the trees will shed their leaves, trusting in the spring they will again be adorned with their green beauty.

Some of you in your mid 30’s or 40s are entering perimenopause, a time when cycles become problematic, and PMS worsens. If you are 50 and above, menopause with its endless “power surges” or “hot flashes” are wearing you down. Many women find nights uncomfortable, often waking several times, drenched with sweat and blankets hurled to the other side of the bed. Moods may be volatile, and memory, a fog. Lack of sleep can lead to fatigue, decreased motivation, and weight gain.

Since the 1940’s, Premarin, isolated from pregnant mare urine, had been the mainstay of treating unwanted symptoms. The Women’s Initiative Trial, launched in 1991 changed this.  Three years into the trial, results showed that Premarin and Provera (medroxyprogesterone), hormones used commonly in menopause, caused an increase in heart attack, stroke, and breast cancer, to the extent that the trial needed to be stopped. Women were taken off hormones, and symptoms returned. In 2007, the data was revisited, and it was agreed that bioidentical estrogen was safest, when given to young women for the shortest duration of time. Bioidentical progesterone was still given to protect the uterus from estrogen’s effect, for it’s calming properties, and alone when women were considered to be estrogen-dominant as often seen in perimenopause.

In 2017, The North American Menopause Society (NAMS) issued a current statement on hormonal therapy (HT). In short, HT is most effective for hot flashes, vaginal atrophy, and osteoporosis. Therapy must be individualized regarding dose, route, sole or combination therapy with bioidentical estrogen, and/or progesterone, be initiated in women without contraindications whose menopause occurred less than 10 years ago, and be monitored regularly for effectiveness and harm. HT does increase the risk for coronary artery disease, stroke, venous thromboembolism, and dementia, especially in older women. For vaginal dryness it is recommended that lubricants such as Replens® be tried before initiating vaginal estrogen.

I have treated many women going through perimenopause and menopause with acupuncture, helping decrease or eliminate hot flashes, night sweats, mood swings, and fatigue. I’ve also seen that symptoms get worse with stressful events, and once an acupuncture series is given, they then improve.

With osteoporosis, herbs must be given, and bone density monitored, just as we do when you are prescribed drugs. For vaginal dryness and atrophy, first the lubricants are given on a regular basis. Chinese herbs and a diet high in okra can be helpful.

For women whose power surges and mood swings are not relieved by acupuncture alone, herbal formulas are given.  Individualized variations of Liu Wei Di Huang Wan, and Xiao Yao wan, processed in labs with high quality control, can have a positive impact without the worry of serious adverse effects associated with HT.

This article appeared in the September Edition of the Rural Observer under the heading "The garden is in but my back is Out" (error in title)

 



Acupuncture and the Opioid Crisis, Part I of III

Acupuncture and the Opioid Crisis Part I of III:
Angela Berscheid Registered Pharmacist, Registered Acupuncturist

Acupuncture and the Opioid Crisis, Part I of III, Hoku Integrated Healthcare in Westshore Colwood, Victoria BCPhoto representing addiction as hopelessness

I’ve been practicing pharmacy since 1988, serving mainly the South Island and the Lower Mainland of BC, and now as a consultant in my acupuncture practice in Victoria. From this time I have seen a great change in physicians’ prescribing of opioid painkillers. This blog will discuss the history of opioids, their use, and factors that have led to our current crisis.

When I graduated from UBC, we referred to these substances as “narcotics”—a term derived from Latin “narcos”—to sleep, and also a term used by Health Canada to regulate illegal drugs.

First, what is an opioid? An opioid is a substance derived from the Oriental poppy Papaver somniferum. The word “opium,” is derived from the Greek word “opion”, meaning “poppy juice”. It was first cultivated in Mesopotamia as early as 3400 BC, where its sap, was collected primarily for its pain relieving properties. It wasn’t until the 1500’s that opium was used for non-medical recreational use. Although cultivation started in Mesopotamia, both opium farming and trafficking moved to “The Golden Crescent” in the area of Afghanistan, and moved along trade routes to the “Golden Triangle” in Southeast Asia. Its use also spread when opium was carried along the Silk Road, a route that travelled from the Mediterranean, across Asia and then to China where the two Opium Wars commenced in the 1800s. To maximize trade, Great Britain sold opium grown in India to the Chinese. Where opium went, addiction followed. In retaliation to Great Britain’s wishes to continue trade, legalizing and taxing opium, the Chinese fought to ban all imports. In the first war, China gave up Hong Kong to Great Britain in order for the opium trade to stop. The second war ended with the legalization of opium. When the Chinese arrived to work on the railroads, its use spread to North America. Empty rusted opium containers have been found in the Nanaimo harbor, relics of those times.

Currently opium farms exist in many warm, dry climates, from the Golden Crescent and Triangle, to Thailand and Myanmar, as well as Mexico, and Columbia, where impoverished farmers, to support their families, sell opium on the black market. There are volunteers travelling to these countries, whose goal is to teach farmers how to grow other crops, but this is proving difficult as growing a legitimate crop has a lower profit margin, and the criminals involved in trafficking put serious pressure on the farmers to continue.

Opium is high in isoquinoline alkaloids, the most potent being morphine (from Morpheus, the God of dreams and sleep) and codeine. These two substances are referred to as “opiates.” All other derivatives are partially or totally synthesized from opium, and are called “opioids.” These compounds bind to Mu receptors to relieve pain and Kaffa receptors to induce sleep. Their Mu1 and Delta receptors cause dopamine, the pleasure and reward neurotransmitter to be released into the bloodstream. Our bodies produce our own natural feel-good and pain-relieving endorphins, but when these stronger drugs are used repeatedly, we can no longer produce, or bind enough of our endorphins to receptors to relieve pain and allow us to feel happy. When this occurs, generally only a small percentage of the population will actually become addicted. It was believed that most people could stave off opioid addiction until recently and I will go into this later in the blog.

Angela Berscheid offers Acupuncture in Westshore Colwood, Victoria BC
Photo of two opium poppy pods

Pharmaceutically opiumitself was made into powders and pills. Being more soluble in alcohol compared to water, opium tincture, or laudanum was widely used for pain, insomnia, cough, and diarrhea. Laudenaum was often prescribed to Victorian women for hysteria, and was misused by many, including Samuel Taylor Coleridge, who in his dreamlike state wrote the famous poem, “Kubla Khan.” Opium dens, where opium was smoked, were commonplace; it was also available in pharmacies, made by manufacturers such as Bayer in over-the counter remedies where no prescription was required.

Morphine was first isolated in 1805; in 1847, the potent opioid, diacetyl-morphine, under the trade name of Heroin, was synthesized to combat opium and morphine addiction. During the American Civil war alone, 400,000 soldiers became addicted to morphine. When it was discovered that Heroin was an extremely addictive substance, its use to treat addiction was stopped. Unfortunately Heroin powder was and is injected intravenously by young Americans to elicit intense euphoria. It was and is also smoked, and inhaled.

Over the years, several opioids have been synthesized for pain relief. They differ in potency and duration of effect.

Withdrawal from, opiates/opioids, though unbearable for many, is not life-threatening on its own, and includes often debilitating agitation, restlessness, sweating, drug craving, extreme anxiety, irritability, insomnia, depression, excessive yawning, tearing of eyes, fevers, chills or cold sweats, panting, retching, cramping, explosive diarrhea, and entire body aches and pains. The duration for acute Heroin withdrawal is approximately 7 days, the first 3 being the hardest to overcome. Some users will be tapered off more slowly to lessen the effects of “Cold Turkey”. For drugs with a longer half-life, withdrawal is longer. Symptoms can occur as soon as 6 hours after the last dose.  The prescription drug, clonidine, is used to lessen some of the effects of withdrawal.

In the late 1980’s Tylenol 3 was the top prescribed prescription medication in BC. I saw it frequently being used for both acute and chronic non-cancer pain, and some physicians would prescribe Percocet (oxycodone) for those who required a stronger medication. Cancer patients were often given morphine to control their pain. Sustained release products were not quite yet on the market. When they were introduced, the current thinking was that long-acting formulations of opioids, such as M-Eslon, or sustained relief morphine, provided around-the-clock pain relief, reduced common blood-level related side effects such as dizziness, drowsiness, sedation, nausea, and vomiting, as well as avoided the rush or high that potential addicts were seeking with the quick acting drugs. Long-acting strong narcotics with small breakthrough pain doses of their short-acting equivalent became the norm in cancer patients.

Hoku Integrated Healthcare in Westshore Colwood, Victoria BC
Photo of the markings on a Tylenol No. 3 tablet

          Fast forward to the mid to late 1990s.  Now patients with chronic non-cancer pain were being given the long-acting/short-acting opioid combination. A study by Katz et al has been referenced as a reason many doctors saw prescribing opioids for chronic non-cancer pain as being relatively safe. I saw patients not only on long acting morphine (M-eslon), but also on more potent drugs, such as fentanyl patches or Hydromorph-Contin, drugs that had before been reserved mostly for those with cancer. The vast majority of these patients were now getting adequate pain relief—from what I saw only a minority was showing signs of drug-seeking behavior.  Yes, some patients had slowly rising dosages, but that was attributed to either a) a worsening of their pain over time, b) tolerance and c) dependence.

          Many people don’t know the difference between “addiction”, “tolerance” and “dependence”. Addiction refers to actual compulsive drug seeking behavior. The addict’s mind is focused on how to get more of their preferred substance in order to “chill” or, in most cases, “feel normal.” Addiction to opioids is more common in people who are alcoholics, taking benzodiazapines such as lorazepam, and/or illicit drugs. Tolerance relates to how a person can “get used to” a certain dose. With repeated dosing of the opioid, the body starts to need more of that substance in order to get the same effect that was achieved with a lower dose. Although I haven’t seen any studies on this, I believe that long acting opioid formulations may contribute even more rapidly to tolerance since the substance is always in the body. Mu receptors get saturated, and the drug has a lesser effect. This phenomenon is also tragically seen in short acting drugs with repeated use. With Heroin, or even prescription oral drugs at high dosages, when the user goes without the medication for several days, they then overdose on what they believed was an amount they could handle. People would and do stop breathing and quickly die due to this phenomenon. Taking the drugs with other respiratory depressants, such as alcohol and benzodiazepines is an even deadlier combination. Here, people totally underestimate their previously tolerated amount and they can’t predict what effect these cocktails will have on their system. Dependence is what occurs when a person has reached tolerance. When this happens, they will go through some degree of withdrawal upon stopping taking the medication. The drug has become part of their “normal” body chemistry.  The effects of tolerance and dependence are often confused with addiction, as the patient would be asking their doctor for increasing quantities of that addicting substance. For most patients, normally supervised prescriptions for opioid medication have worked well and haven’t created a lot of addicts.

          I, like most pharmacists and doctors, however, did notice an alarming rate of abuse, first with long-acting oxycodone, prescribed as Oxycontin. Looking into this further, we discovered that people had started snorting, injecting, and even combining the crushed powder into various cocktails to get high. The street value of Oxycontin rose, and more pharmacies were being broken into. People were coming from outside of the province to try to fool the medical system to get more of this drug, only to find that we, in BC (and now in many provinces) have a valuable tool called “Pharmanet” that monitors all prescribed medications from any doctor to each specific patient. All it takes is one phone call to alert the doctor.

Even this wasn’t enough to stop the abuse, so the BC College of Pharmacists banned Oxycontin, and OxyNeo, a new sustained release formulation that was “snort-proof” and “injectable-proof” came on the market. This made a great impact on this wave of abuse.

Acupuncture and the Opioid Crisis, Part I of III, Hoku Integrated Healthcare in Westshore Colwood, Victoria BCPhoto of young woman with handful of pills

Now, however, we are faced with an opioid epidemic where countless people are dying each day due to overdosing on both prescription opioids and Heroin. Physicians are doing everything they can to not prescribe opioids to anyone. Their valid fear is that they will be the “well-meaning” physician that is responsible for getting one of their patients hooked on an opioid, and then get that 3AM phone call saying that their patient has died of an overdose. Walk-in Clinic doctors do not prescribe any opioids, and The BC College of Physicians and Surgeons has stringent guidelines regarding their prescribing. Still the epidemic worsens. You would think that random urine testing and the vigilant use of Pharmanet would have a stronger impact than it has had so far. I strongly believe that all pharmacies, physicians’ offices, and Emergency Departments should have access to a current online monitoring database. This would catch potential prescription drug abusers. The random urine tests would identify those that are using more than one substance, or none at all, as in those who are only selling or giving away the drugs.

          There are quite a few factors involved here.  First, there seems to be a relatively stable percentage of the population addicted to something—be it alcohol, cigarettes, sedatives, stimulants, opioids for recreational use, and other drugs.  This means that no matter what the interventions we have made so far, we will not have an impact on the percentage of addicts in North America. From 2002-13, heroin use has increased from 404,000 – 681,000 (number of users in the USA that have used heroin in the last year). When it comes to the use of prescription opioid pain relievers, people between the ages of 16-24 have the highest user rate, though not the highest overdose rate. Overall the percentage of people over the age of 12 using prescription recreational opioids was 1.9% in 2002, and 1.7% in 2013. No change. What is alarming is that most people who use opioids for recreational use get them from friends or family. In 2012-13, 53% got the pain relievers from a friend or relative. 14.6%, bought or took them from a friend or relative; 21% got them from their doctors, and 2.6% from more than one doctor. Only 4.3% got the prescription opioid painkillers from a drug dealer or a stranger.  

When these American statistics became known in 2013, prescribing habits of doctors had to, and did change. According to this data, friends and family are responsible for giving and/or somehow releasing over 3 times the opioid prescriptions compared to the doctors who originally prescribed the same drugs. We, as a society have to get smarter. This is not just a drug problem, it’s a societal problem, and because of this, doctors have practically shut down on prescribing opioids, to the chagrin of people who are in severe chronic pain, some of which will, according to these stats, turn to their friends and family for relief; if that is not available, then a small few do turn to the street, and these will likely die from overdose.  

Besides drug diversion, there is a greater reason why people are dying from opioids. Yes, Heroin use is on the rise. Why, though, would more Heroin users be dying of overdoses over a prolonged period of time? In the past, we would see waves of users overdosing on Vancouver’s streets due to more potent forms of Heroin becoming temporarily available when it made its way to the coast. Users would shoot up their regular dose, and die of respiratory failure. Once that more potent supply was gone, the overdose rate would normalize. This still occurs, but now we have fentanyl, and fentanyl analogue powders being smuggled to North America.   According to the University of Idaho, Fentanyl is 100 times stronger than morphine, and can be 100 or more times stronger than Heroin. Its derivatives, of which there are many, are up to 20,000 times stronger than Heroin. These powerful drugs are cheaper than Heroin, so they are often used to dilute, or “cut” it. Carfentanil, and W-18 are 2 examples. It should be noted, that when searching on the Internet, there are clearly some unknowns when it comes to estimating potencies. This is likely due to the many super-potent fentanyl derivatives of varying strengths that are on the market. Heroin can also be cut with an unknown percentage, and since some fatal dosages are invisible to the naked eye, minute variations in the weighing process can be fatal. Furthermore, potencies of these black market substances vary not only between illegal labs, but from batch to batch as well. It is agreed that a microscopic amount to a few grains of these derivatives are lethal, and stop breathing very quickly. Under the right conditions, the size of a grain of salt can kill 30 people! Many street drugs are tainted with these compounds, from heroin to Percocet, to benzodiazepines such as triazolam or diazepam, and people are dying of respiratory failure with alarmingly increasing frequency.

Angela Berscheid offers Acupuncture in Westshore Colwood, Victoria BCOn the left,a lethal dose of Heroin; on the right, a lethal dose of fentanyl. Photo courtesy of New Hampshire State Police Forensic Labs

This is likely the reason that heroin overdoses, according to the CDC, have quadrupled from 2010 to 2014. From 2014 to 2015, heroin overdose death rates increased by 20.6%, with nearly 13,000 dying in 2015. In the same year, men aged 25-44 had the highest heroin death rate at 13.2 per 100,000, which was an increase of 22.2% from 2014. This is American data, and anecdotally the stats are increasing.

Newest data for the city of Vancouver, BC in August 2017, according to Global News, shows that there have been 232 suspected "illicit" drug overdose deaths so far this year, more than the total for 2016. At this rate, it is expected that there will be 400 overdose deaths this year alone. First responders are getting, on average 135 overdose calls a week. 

Meanwhile, I’ve also been hearing several physicians referring to studies that suggest opioids do not work in chronic non-cancer pain, and that other drugs, such as NSAIDs (naproxen, diclofenac, etc), antidepressants (such as Cymbalta, amitripylline), anti-seizure medications (gabapentin, Lyrica, topiramate), muscle relaxants (cyclobenzaprine), topical NSAIDS with lidocaine, etc, especially in combination are more effective than opioids. These drugs however, are not free from side effects, such as gastrointestinal bleeding with NSAIDs, and varying degrees of sedation in many of the others. Though most side effects of these drugs are considered to be mild for most, some of the infrequent adverse effects of these drugs can be lethal, though more deaths have been recently attributed to opioids. These drugs are not considered to be addictive. Some patients respond well but others don’t.

Sometimes the synthetic opioid, tramadol, that is thought to have less abuse potential, is given for mild to moderate pain relief. Although it is a little less potent than codeine, it may be more effective in neuropathic pain, but it does have the potential for more serious side effects, drug interactions, and costs far more than codeine. It is my belief, that over time, we will see an increasing number of patients abusing tramadol.

When looking at meta-analysis of opioids in chronic pain, the consensus, if there is one, is that there is a lack of data for their use in chronic non- cancer pain. Some meta-analysis trials state that opioids are indeed effective, but physicians must be careful due to their addiction potential.

“More study is needed”. Accordingly, instead of being first line therapy, due to potential for abuse, opioids have become 2nd, 3rd (or “never”) choices for treatment. 

Since it is estimated that up to 40% of people are in some degree of chronic pain, an answer is needed. The drug combinations mentioned above do not work for everyone. We can’t just ignore those who are in urgent need of pain relief, but we cannot contribute to the epidemic.

This opioid crisis is real. It is killing not only strangers, but friends, and family too. Addiction and drug abuse cross all demographic borders, hitting the educated, the uneducated, those with high incomes, and those with low. Recent information in Canada reports that First Nations people are being struck with this disease relentlessly.

In the next blog I will be discussing overdose—ways in which we can prevent one, how to recognize the early stages, and how to quickly and correctly administer emergency treatment.

Part III will focus on non-drug measures in treating chronic pain, and how acupuncture treatments and Traditional Chinese Medicine philosophy can help people in chronic pain, who also suffer from fatigue, anxiety, depression, insomnia, and poor memory.

References:

http://www.ch.ic.ac.uk/rzepa/mim/drugs/html/morphine_text.htm

http://natoassociation.ca/opioids-in-the-golden-crescent-production-trafficking-and-cooperative-counternarcotics-initiatives/

http://www.webpages.uidaho.edu/psyc472www/PDF/6_1_Opiates_Opioids_Narcotics.pdf

https://www.acsh.org/news/2017/01/17/if-you-think-fentanyl-bad-10663

http://journals.lww.com/spinejournal/Abstract/1998/12010/Opioid_Therapy_for_Chronic_Noncancer_Back_Pain__A.14.aspx

https://www.cdc.gov/drugoverdose/data/heroin.html

https://www.deamuseum.org/ccp/opium/history.html

https://en.wikipedia.org/wiki/Golden_Triangle_(Southeast_Asia)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/

http://annals.org/aim/article/2089370/effectiveness-risks-long-term-opioid-therapy-chronic-pain-systematic-review

https://harborvillageflorida.com/uncategorized/whats-difference-heroin-vs-fentanyl/

https://www.ncbi.nlm.nih.gov/pubmed/18443639

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1459894/

http://globalnews.ca/news/3685261/city-of-vancouvers-2017-drug-overdose-numbers-already-surpass-2016-total/

 

 

My Garden is in, but my Back is Out. How to Prevent Back Pain and How to Treat it with Acupuncture and Conventional Medicine

          My Garden is in, but my Back is Out. How to Prevent Back Pain and How to Treat it with Acupuncture and Conventional Medicine, Hoku Integrated Healthcare in Westshore Colwood, Victoria BC

 

          This month’s blog will discuss how to protect your back from injury, and what conventional medicine and acupuncture can do for you. A smaller version of this blog is in July's edition of The Rural Observer .

            In the Sooke area towards the end of June, we finally had enough warm weather to get our gardens dug, and planted. Gardening is, however, a form of seasonal exercise involving a lot of awkward positions. We are unaccustomed to shoveling, lifting, and bending for several hours a day and are just now getting quite accustomed to weeding or pruning.  If we are not careful, these repetitive motions can cause the muscles of the back to tighten up, resulting in anywhere from mild to severe back pain.

          It’s wise to use a common sense approach aimed at putting less stress on the spine when gardening. First warm up by taking a 5-10 minute brisk walk, then gently bend forward from your hips. Rub your lower back with your palms to get the blood flowing to your muscles. Avoid the marathon by gardening for only one-half hour per day. This means getting at the weeds when they are only just poking through the earth, and not a foot tall! You will be wishing you did if you have any thistles. Buttercups and dandelions can easily run amok, as do blackberries. In the past I've had blackberries that have easily grown a foot in one day, especially at the beginning of the season, and if there was a plant that could "win", it would be that one.

          Ideally, every 5 minutes, gently stretch, extending your back. Never stretch so far to cause you any pain, and don’t bounce. If you already suffer from low back pain it is suggested you see a doctor before starting any exercise program, and it is essential to have a daily stretching routine. Spine-health.com and Healthlink BC offer specific back stretches. I highly recommend Tai Qi or yoga done on a daily basis. Always respect your body's limitations, and trust what your body is telling you. 

          When outside and busy it’s easy to become distracted by the tasks at hand, then become dehydrated, so keep a bottle of water handy. Try alternating tasks to avoid putting pressure on one area of your body for too long, and use tools that decrease bending. When lifting heavy objects, squat to pick them up and keep them close to your body. If you need to turn, do so by shuffling your feet, not by turning from the waist.

          Gardening chairs, “kneelers”, knee-pads and/or mats help you stay close to the ground. Raised beds, preferably at 3 feet, are optimal. If you are wanting to revamp your garden, perhaps look into "Square Foot Gardening". This method saves space, water, and time. It also protects your back since you don't have to over-reach to weed, or make your harvest. If you live on a hill, consider terracing.

          If pain occurs, icing (over a towel to avoid freezing your skin) is generally recommended, for up to 2 days. RICE: Rest, Ice, Compression, and Elevation after an acute injury has been the mainstay of treatment from an allopathic point of view, and I would suggest this to people with acute injuries coming into the pharmacy. When the pain starts to resolve, then alternating hot and cold compresses would then be recommended. In 48 hours, application of Hot compresses brings oxygenated blood to stiff muscles, allowing them to heal and relax. As far as I know, this is what most medical doctors, nurses, chiropractors and physical therapists still recommend. From a Traditional Chinese Medicine point of view, however, applying ice can slow down the healing process, but will provide pain relief. If over-used, ice could cause problems in the affected joint further down the road. Todd Howard, of Pacific Rim College in Victoria, BC, discusses this in his article, The Fallacy of RICE. Being trained in both approaches I take each case individually. I will recommend RICE if there is a great amount of swelling and pain, but only for the shortest time possible. Swelling is nature's way of immobilizing a joint, and of bringing the cascade of healing factors from the inflammatory process to heal the joint and surrounding muscles. I'm not saying to "just suck it up"; my advice is if you can't tolerate the pain and need to take a medication to get through it, then ice the area. If it's not that painful, then take it easy for a few days and let your body heal. See an acupuncturist. This is an area where TCM thrives. We don't apply one approach to everyone.

          Conventional medicine offers anti-inflammatories such as ibuprofen and naproxen—they should be taken with food to decrease stomach upset, and are not to be used if you are taking blood pressure medication, warfarin, or blood thinners. These drugs can cause perforation of ulcers, as well as gastrointestinal bleeding. Recent studies show that in people who have taken a non-steroidal anti-inflammatory within 12 months of having a heart attack have a higher rate of mortality. This latter effect does not include ASA, or Aspirin; acetaminophen can be used as a pain killer but does not take away any inflammation. Be sure to stay within the recommended dosage range to avoid liver toxicity. Muscle relaxants, such as Robaxacet (has acetaminophen), Robaxisal (has ASA), Robax Platinum (has ibuprofen) all contain methocarbamol which can help for muscle spasms. It tends to cause drowsiness, sedation, and dry mouth, especially when combined with codeine. Robaxin is "straight methocarbamol" and doesn't contain the other ingredients. It is available behind the counter. The most commonly used prescription muscle relaxant is cyclobenzaprine. It too tends to cause sedation, drowsiness, and dry mouth. None of the muscle relaxant products should be taken with alcohol or marijuana due to additive sedation.

        Opioids, most of which are derived from the plant Papaver somniferum all cause drowsiness, sedation, and respiratory depression; they should never be combined with alcohol, and should not be taken with other drugs with sedative effects. Codeine, in Tylenol No. 3, or oxycodone, in Percocet, are no longer being prescribed due to the Opioid crisis, where in some locations, overdose deaths due to opioids surpasses deaths due to cancer or cardiovascular disease; some physicians who know their patients well will prescribe very small amounts of codeine, or tramadol in acute pain situations, but very carefully with much supervision. There are many factors influencing this epidemic, and I could easily write an entire blog devoted to it.

        Topical pain relievers can be used—I find the menthol containing ones to be more effective than the newer low dose topical anti-antiinflammatory cream, unless at a higher prescription dose. Traumacare®, a homeopathic cream may be beneficial. 

        The number one reason people seek acupuncture is for back pain. Why? Because it works well by regulating blood flow to the painful area(s) and relaxing tight muscles, thus relieving pain. It may be combined with Tui Na (Chinese Massage) using oils such as White Flower®, or application of Zheng Gu Shui® if there is bruising. "Cupping” is often used, which creates areas of suction that relieves swelling, pain, and inflammation, without slowing down the healing process. You may have seen the round “hickeys” left by cups on some Olympic athletes, such as Michael Phelps. Athletes at this level are using any proven approach to enhance their performance, to legally gain advantage over their competitors.

            In some styles of acupuncture, needles are inserted into acu-points on or near the area. This causes a local histamine response that encourages healing through a small inflammatory response. Muscles then relax, and blood moves to the area. In other styles, such as "The Balance Method", "Master Tung Acupuncture" and "Distal Needle Acupuncture®", needles are inserted in areas further away from the pain. Acupuncture meridians in the area of your ankles, wrists, and even scalp are chosen. It is thought that this approach works by engaging the area of the midbrain responsible for releasing endorphins and enhancing blood flow to the injured areas, encouraging healing. Clinically, I will often use the distal approach as it doesn't cause further inflammation to an already hurt area, and my patients report pain relief occurring in seconds. In either approach, Tui Na and cupping can augment the treatment. 

          If you are in pain, don't needlessly suffer. Give me a call.

Angela Berscheid offers Acupuncture in Westshore Colwood, Victoria BC

Spring is in the Air...But I can't smell it: How to get relief from Seasonal Rhinitis with acupuncture and Traditional Chinese Medicine

            After what seemed like a never-ending winter of rain and snow, at last spring has come to Southern Vancouver Island. Now airborne pollens are on the rise, and so are allergies.

           Many people aren’t sure if they have seasonal rhinitis, also known as “hay-fever”. If you have itchy eyes, nose, and throat, have sneezing with a clear nasal discharge, and/or have nasal stuffiness that seem to come at the same time each year, it is likely you have it.  Some people, however, can have these symptoms continuously as they are allergic to household and environmental substances present throughout the year. Symptoms occur when your body overly responds to certain foreign substances called allergens, releasing histamine. Treatment in conventional medicine includes antihistamines, glucocorticoid sprays, and sometimes, inhalers if there is wheezing.  It is important that you see your doctor if you have any difficulty breathing. Be careful when choosing over-the-counter nasal sprays. Those with decongestants, when used for more than 5 consecutive days can cause rebound congestion, leaving you with a stubborn plugged nose. They are also not to be used by people who have high blood pressure.

           If, however, you have yellow or green nasal discharge for over 10 days, often accompanied with a headache, this may be a bacterial infection (sinusitis). If you have mild nasal stuffiness with a very sore throat and high fever, this may be a streptoccal infection— again it is prudent to see a doctor.

           TCM treats allergies in two ways. Practitioners help patients by “releasing the exterior of Wind-Cold or Wind-Heat”, which means decreasing symptoms. We also help build up your constitution, and detoxify your liver so you are less likely to succumb to allergies.  Specific acupuncture points are chosen to treat symptoms, and build “Zheng Qi”, which strengthens resistance. As in treating asthma, we often focus on these tonifying treatments when you are symptom-free, for example, in the Fall and Winter, so you will be more able to resist the allergens when they occur.  Don’t worry—it is never too late!  If you are having symptoms now, the focus of treatment is on their alleviation. Once the allergies have subsided, then the strengthening treatments can commence.

           You can help by keeping your windows closed if you are allergic to pollen, broom, or grasses. Keep windows free of mould. If you are allergic to dust mites or pet dander, then it is suggested to frequently dust, and vacuum your floors, mattress, and pillows.  A HEPA filter in your home may be beneficial.  A change in diet, a topic on its own, often decreases your symptoms. Using a Neti Pot (an Ayurvedic nasal clearing technique), or “medi-rinse” with normal saline twice a day, flushes out allergens and mucous. You can purchase the saline packets, or make the solution at home with purified water.      

           In summary, TCM can help stop and prevent allergic rhinitis symptoms. In addition, modifying your diet, identifying your allergens and taking steps to eliminate them from your environment will help you be able to stop and smell the flowers.

The above was published in the May edition of the Rural Observer at http://ruralobserver.com If you have any questions feel free to send me an email, or give me a call.

The 8 Secrets of Traditional Chinese Medicine

        Secrets? While many of us have heard of acupuncture, the term “Traditional Chinese Medicine” (TCM) remains a mystery. Here, I'll give you a better understanding regarding this complex therapeutic method.

      TCM, which originated approximately 4000-4500 years ago, consists of what are called eight “limbs” or practices and techniques that are used to maintain health. They are listed in order of decreasing importance:

1.     Mind—this refers to meditation and relaxation techniques;

2.     Exercise—classically the martial arts, including Tai Qi and Qi Gong;

3.     Diet—prevents and treats diseases with carefully selected foods;

4.     Feng Shui—living in accordance to the harmony of the 5-elements;

5.     Astrology—used as a guide to treatment;

6.     Chinese Massage (“Tui Na”), Cupping, acupressure, and in some cases, applied Qi Gong;

7.     Herbs—This is an area where a lot of us that have been misled by the media. Often when I mention Chinese Herbology to people, they tell me that bear bladders, rhinoceros horns, and even monkey brains (though the latter is from a Harrison Ford movie), are being used often in TCM. It is truly unfortunate that there are poachers that are making a lot of money for these so-called remedies, putting these and other animals at risk, but rest assured that use of endangered herbs/animals is illegal in Canada. Registered TCM herbalists in North America do not use these species. The Chinese Materia Medica is extensive, including mostly plants, shells, and very few members of the Animal Kingdom. I use plants and a few shells in 99% of my formulas. Quality control is stringent for North American TCM herbal manufacturers. They must adhere to the strict "Good Manufacturing Practices" in both the US and Canada. Herbs are not only checked for quality. They are also checked routinely for toxic components and contaminants. 

8.     Acupuncture, best known for it's use in alleviating pain, is the insertion of very fine needles into acupoints to achieve a therapeutic effect. In North America we use sterile, prepackaged, medical surgical steel grade needles, that are used once, then disposed of in a sharps container that will later be incinerated at high temperature. All registered acupuncturists are to follow "clean needle technique". Practitioners must pass acupuncture (and herbal) safety tests before they are even allowed to write their board exams.

The first 5 limbs are tools we can learn that empower us to take care of ourselves. When healthy, practicing these techniques regularly can prevent serious illnesses. Common sense tells us that relaxation techniques, Tai Qi, yoga, and aerobics/Zumba/Jazzercise/ or walking 10,000 steps a day... When combined with weight bearing exercise, a proper diet and a healthy living environment, this should keep us healthy. This is why TCM is called "gardening medicine". It cultivates a life-style that prevents many diseases. Regular practice would save us a lot of discomfort, and along with our overloaded healthcare system, much money. Did you know that in ancient times, Chinese doctors were not paid if their patients became ill? Today, in Canada, if you go to a conventional medicine walk-in clinic and the doctors have met their "quota", they have to shut down for the rest of the day. Times have changed.

As only the last 3 limbs require a practitioner’s aid, we can see that the focus of TCM is on the maintenance of health and the prevention of disease, allowing us to live in a state of balance where we and our loved ones can fully enjoy life. We can enjoy our tasks and feel like ourselves again. It is unfortunate that in North America, acupuncturists do, however, often treat people seeking us as a “last resort” when all else has failed. As a rule, the longer the duration of illness, the longer the duration of treatment required. It is thus best to start treatments before symptoms become severe. Ideally when we start to feel a little "off", this is the best time to see an acupuncturist, instead of leaving it for several years with a worsening of symptoms and accompanied grief.

Now you know the 8 secrets of Traditional Chinese Medicine. They are the 8 limbs.

In conclusion, I would like to wish all Roosters a happy birthday. People born under the year of the Rooster (2017, and every twelve years before or after that, according to the Chinese Lunar Calendar) tend to be hardworking, resourceful, confident, and talented.  Their talkative and engaging ways make them popular; they enjoy the spotlight but can be seen as vain or arrogant. Some famous roosters include Rudyard Kipling, Eric Clapton, Jennifer Lopez, Yoko Ono, Steve Martin and Groucho Marx. May you enjoy peace, joy, health, and prosperity in this Year of the Rooster.

 

In Between Winter and Spring: TCM and the 5-elements

March 2/17: Today as I'm writing, I can hear the robins outside singing their "Spring Song", while 2 days ago there was snow on the ground. This brings me to a truth that occurs during the "in-between" time of Winter transitioning to Spring.
All going well, the sap of the trees begins to rise, and plants begin to sprout, coming out of dormancy. We humans, parallel this behaviour. We spend the Winter in storage mode, in front of our fires (or TVs) enjoying what we have harvested in the fall. We don't tend to take on new projects and are happy with the status-quo.
In Traditional Chinese Medicine we call "Winter" the element, or more correctly, the phase of "Water". Following Winter is "Spring", or the phase of "Wood". During this transition of these 2 phases, we start to naturally feel the pull of Spring. Our energy starts to rise like that of the sap in the trees, and we start to more energetically plan our gardens, looking more seriously at our seed catalogues, or plan to get more projects done at work or around the house.
This is all well and good, right? When we follow nature's call, or follow the 5-phases (elements) seen in Traditional Chinese Medicine, we tend to stay happier and healthier.
Clinically, this time of year, I see two main imbalances start to occur.
The first? There are quite a few people who get stuck in Winter-mode and just don't have the energy to do anything when Spring finally arrives. They are sluggish, tired, and aren't planning on doing anything. What I do in this case, is to help them overcome the blockage with acupuncture, often classically, moving Qi from Water to Wood phase; allowing the energy to flow in accordance with the 5-phases, imparts more vitality.
The second? People come into my office feeling overly cranky and suffering from migraine headaches. These people have jumped rather quickly out of Water into Wood, and their "sap" has overly risen to their heads, which manifests initially as frustration then as migraines. With these patients I help them anchor the Qi, or "sap" so it doesn't rise so quickly and get out of control. Acupuncture in this case helps to balance the rising up, yet allowing the call of Wood to occur in a more balanced manner.
This could be why February is such a frustrating month for so many Canadians, especially on the West Coast where Winter and Spring are co-existing. We feel the pull of Wood, and are held back by the chill of Water. Have faith. Soon the nettles will be up. Spring is coming.