A Doctor's Notebook

By Andrew Ivanchenko

It is not easy to speak funny way about serious things, to talk in plain words about a complex subject, to explain medical topics easily and at the same time in a professional manner. This book gives you this rare opportunity. Everything you read here is the result of doctor's practice and experience in popular broadcast shows and a Russian newspaper's medical column in Chicago.

• Language: English
• Publisher: Lulu.com
• Release date: Mar 10, 2017
• ISBN: 9781365814570

Book preview

A Doctor's Notebook

Talking Medicine the Easy Way

Authored by Andrew Ivanchenko

It is not easy to speak funny way about serious things, to talk in plain words about a complex subject, to explain medical topics easily and at the same time in a professional manner. This book gives you this rare opportunity. Everything you read here is the result of doctor's practice and experience in popular broadcast shows and a Russian newspaper's medical column in Chicago. 

Ivanchenko1

Doctor A. Ivanchenko

The Tragedy of Medicine

Someone might consider this heading provocative. How it is possible, the reader may ask, that in a time of such enormous achievements in all fields, can someone talk about some kind of failure of medicine? But the discussion is not about the science of medicine or medical technology, but about the art of medicine and a genuine doctor image, as they were known throughout history not just a medical professional, but actual personality that is philosophical, wise and with a lifetime of experience -- a renaissance man in the likes of Benjamin Rush, Charles Mayo, or William Osler. 

Once, Antoine de Saint-Exupéry said (long before the invention of the computer) that the near future world of medicine would have a machine that could analyze a simple blood sample and write out a complex prescription with missing vital chemical elements and medicines that could heal a man without the help of a doctor. But, he continues, "When I get sick, I would rather see some country doctor, someone who would glance at me, feel my pulse, my stomach and listen to my breathing through a handkerchief. Then he would clear his throat, take a puff from his pipe, scratch his chin and then, in order to better heal me, smile.... Rationally I respect science, but I revere wisdom just as deeply.' 

Today, we come very close to the fulfillment of that wildest dream of the 1940s, while at the same time, we approaching even more rapidly to the complete inability to find the kind of doctor that the great writer imagined. The reason behind this is not only the difficulty in modern medicine and its growing specialization, nor the abundance of medications that could not have existed in any previous century. The reason is the change in a doctor's mentality and education.

In earlier times, a doctor was inevitably also a philosopher, able to see the power of disease and the power of the body self-healing. It was impossible to cure someone just using medication. That is why medicine was not so much a science as the art of restoring a body's ability and potential to heal and protect itself. That is why a doctor would look at the entire patient, in complete interaction of the internal organs, the nervous system, his mental and environmental balance.

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To understand this most complex conglomerate of incoming data and find the right remedy, doctors need to be, on one hand, scientists    what's more, they should not only have extensive knowledge of symptoms and medicines, but also understand body physiology at a profound level     and at the same time, they should, on the other hand, be well versed in logic and rhetoric, able to form an intelligent chain of conclusions and able to relate their ideas to their patients in the clearest form. That is why many men of medicine were also powerful writers: Benjamin Franklin, Walt Whitman, Sir Arthur Conan Doyle , John Keats.

Today, a student's effort to think independently might be met with questions like, What journal did you read that in? What is the name of the study? Is there reference to it? After one makes an attempt to explain that this is a conclusion from the laws of physiology and pathology the frequent answer would be: Stop blowing smoke! It is very similar to the harsh slogan reflecting the position of physicists toward philosophy: Shut up and calculate! The price we have to pay for this high, yet dry, pseudo-scientific perfectionism will be the doctors turning into heartless technicians applying tests, pills and medical technology to every patient     becoming something like half-mechanic and half-accountant.

Maybe for the medical science and statistics of recoveries, this would be beneficial. But the patients can already smell something wrong and are getting alarmed. Yet many doctors themselves realize that the promise of absolute accuracy and scientific guarantee puts them in danger of lawsuits which snowball effect forces them to avoid talking genuinely to their patients in order to say nothing odd, which already creates a talking computer effect.

This is just a list of sad facts and concerning thoughts for which I have neither answer nor cure. But in many cases, awareness of a problem is the first step to solving it. And, as the proverb says, the journey of a thousand miles begins with a single step. Hopefully, this one can serve as an attempt to make that first step. Let this book will serve as a first step on this long road.

INTEGRATIVE MEDICINE, REHABILITATION AND SELF-HEALING

WHAT IS THERE TO INTEGRATE IN MEDICINE?

The human body is the best picture of the human soul. 

Ludwig Wittgenstein

This introductory chapter, as well as the book itself, is about the integration of health sciences, that is, a return to the holistic concept of health. Time has come to gather the scattered stones of medical knowledge and develop a new approach called integrative medicine. 

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A Past Unfortunately Forgotten 

The word integrative comes from the verb to integrate, that is, to unite or form a single whole. It is the opposite of differentiate, or to divide and split. Differentiation, or narrow specialization, has been the cornerstone of medicine since the late 19th century. 

A narrow specialist deals with his or her own part of the body, occasionally even with a single medical condition. Some argue there is nothing wrong with this philosophy. Indeed, given the incredible current progress in science and technology, it is not easy for, say, a heart surgeon or an oncologist to keep track of news in other fields of medicine. Specialization has been the engine of amazing breakthroughs that save patients who would be doomed a mere three or four decades ago. 

On the other hand, that same specialization means that more and more doctors fail to see the forest for the trees. In other words, a narrow specialist often ignores his patient’s general health as the ultimate goal of any medical treatment. The holistic concept of medicine is now all but lost. As a response to this lamentable situation, integrative medicine was born, a discipline that combines the mainstream science with complementary and alternative medicine.

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Integrative medicine as a science emerged in 1992, while the term itself has been used since 1993. 

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Yes, we certainly enjoy an excellent national health care system designed to be the main framework for dealing with all health-related problems. Unfortunately, a closer look at the structure of this mammoth mechanism makes one wonder how loosely it is connected with health per se. Even Soviet Russia had a public health system with regular checkups and a network of rehabilitation resorts. The United States has made enormous progress in the treatment of complex, serious and chronic diseases, yet general health as such is mostly a matter of interest for laymen. On the one hand, accomplished medical experts have little time or desire to deal with health. On the other hand, crowds of ardent amateur healers with some pseudo-scientific background hardly know anything about the professional health science.  Quite a paradox, right?

So, what is integrative medicine?

The bizarre imbalance that I have just described is addressed by integrative medicine, a relatively new discipline that has been gradually making it into medical school curricula in America. Integrative medicine investigates the mechanisms of biological control and self-healing at the cell level and analyzes genetic processes. It also assimilates ancient medical traditions and concepts (that may occasionally seem quite exotic) with a goal of merging them with the mainstream science. 

Such integration has barely started so far. Nevertheless, it has a definite goal, that is, to develop a universal medical language that would unite various fields of health science and use clear terminology understood by medical professionals and patients alike. All innumerable branches of medicine that deal with specific maladies have yet to come under a single umbrella of the universal health science. We do have ample knowledge of disease symptoms and mechanisms, we know how medication works - but then again, body self-control and mechanisms of self-healing still remain pretty obscure. 

Doctor-patient relationships also need to be integrated. Today’s passive subjects of medical treatment should start playing a key role in the healing process. Indeed, the patient stays in the company of his body around the clock, while the doctor inspects it once a week at best. A doctor-patient tandem has a much better chance to defeat disease; conversely, a patient who encourages his ailment reduces such chance. 

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Integrative medicine does not address isolated symptoms or even a system of organs. Instead, it regards the whole body as a self-controlled computer.

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Integrative medicine is not about isolated symptoms or even body systems. It regards the whole body as a self-controlled computer. It endeavors to explain and address various medical conditions in terms of a single body system. It takes into account all processes and problems in the organs and tissues that may seem unrelated to the disease. 

Amazingly, the muscular system turned out to be the answer to many health problems. For centuries, this system has hardly been a priority for medical science since it is situated on the surface of the body. Doctors believed that muscle problems were always secondary to inflammation, traumas, diseases of joints and the nervous system. However, a closer look has demonstrated that deep muscle processes such as spasms, pain, inflammation or poor circulation are the first signs that point to the general weakening of the body as a whole. In fact, the reflex muscle-ligament chains in the body have been found to follow the pattern of Chinese acupuncture meridians!

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The art of Tai chi is believed to date back to the rule of Emperor Futze (III millennium A.D.) who asked his doctor to create The Great Dance that would prevent and cure many diseases and could be used for martial arts training. 

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In the light of such recent discoveries, it became clear why ancient healing schools were so keen on muscle movement and stretching. Gymnastics in Greece, yoga in India and tai chi in China were all meant to make a reflex impact on the neuromuscular keyboard of our biological computer. 

Much progress in this area has been made since the late 20th century due to the rapid development of manual vertebral neurology. The achievements of American osteopaths and chiropractors, European physical and manual therapists and the mainstream medical science gave a second life to a past well forgotten. Integrative medicine treats spine and joint pains using the most efficient techniques from various rehabilitation disciplines as well as from non-traditional medicine such as spinal manipulations, neuromuscular relaxation, myofascial decompression of herniated nerve roots, acupuncture or motion therapy.  

How does integrative medicine work?

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The doctor needs to precisely identify the particular segment of the locomotor system responsible for the pain.

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Let us look at an integrative medicine practice, namely the rehabilitation center run by the author in Chicago. 

Since I am a pain specialist, my primary task at the first appointment is to make the precise diagnosis. In our terms, diagnosis is not merely a fancy word like neuritis, radiculitis or spinal disk herniation. The doctor needs to precisely identify the particular segment of the locomotor system responsible for the pain. Such a segment is not necessarily located in the painful area.  Say, neck or shoulder pain may be due to sacral displacement. Thoracic spine problems may initiate knee pain.  Locating the primary source of pain is critical. The next step is to identify the specific harmful condition such as herniation, muscle spasms or inflammation and consult with the appropriate specialist. 

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Note that in case of displacement or herniation, muscles need to be relieved before the joint itself.  

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Note that in case of displacement or herniation, muscles need to be loosened prior to the joint itself.  Joints are held in place by the muscles and move where the muscles pull them. This is why experts in relaxation and rehabilitation of injured muscles are indispensable at the first stage of the healing process.  With the help of massage therapy, they can painlessly eliminate spasms and restore blood circulation even in the most sensitive muscles. We also employ a technique known as neuromuscular massage to treat the so-called trigger points (areas where muscular fibers agglutinate into tender nodules because of inflammation or spasms).  Neuromuscular massage is a special technique to exert concentrated pressure on individual muscles. 

If strong spasms turn a muscle into a solid rock that squeezes the spine, it needs to be stretched by a specialist using myofascial decompression. This rare technique reminding of a passive yoga exercise works like a powerful yet delicate machine to relieve and stretch muscle tissues. 

Soft decompression instead of rough techniques

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I believe in a simple principle: when a joint is ready, it can be released without undue force.

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Once the muscles are completely relaxed, it is time to softly decompress the herniated tissue. My method has little in common with rough manipulations used by some manual therapists in Europe and chiropractors in the USA. I never break, pull hard or reset.  I believe in a simple principle: when a joint is ready, it can be released without undue force. Moreover, I would often ask the patient to stretch his body or exert some mild additional pressure on my hands to achieve a soft click meaning full decompression. We also use acupuncture, the most traditional of the non-traditional medical techniques.

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Neuromuscular massage is a special technique to exert concentrated pressure on individual muscles. 

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The final stage of integrative therapy

Once the muscles are relaxed and relieved of spasms and inflammation, time comes for the key stage of treatment at which they are strengthened and retrained to operate properly. This is the job of an exercise therapist who knows all the secrets of resilient and hidden skeletal muscles located near the spine and usually responsible for lumbar, neck or joint pain.   

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Pilates is a physical fitness system developed about a hundred years ago, by Joseph Pilates, a sports expert. 

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The above general description covers just the core of integrative medicine. For best results this core has to be complemented with the right diet (including food supplements) and exercise therapy based on yoga, tai chi or a similar system.  Pilates, hydrotherapy and mud baths can be added too, as well as - ideally - psychotherapy and respiratory muscle training.   

This comprehensive approach leads to incredible results that can be hardly achieved by traditional methods that address each health problem separately. 

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TREATMENT OR HEALING?

Natura sanat, medicus curat morbos

The physician treats, nature heals.

Hippocrates

The two terms often used in the context of health care are treatment and healing (rehabilitation). How are they similar and yet profoundly different?

12

Medical treatment as a way to restore good health

Medical treatment is often invasive. It regards the body as a mechanical system or a passive object. In certain cases, this approach cannot be avoided. For instance, when a cardiac arrest victim hovers between life and death and stops breathing, her vital systems must be restarted at any price.    Forceful treatment is also inevitable in case of a grave infection and in many other situations. In most instances, however, any illness triggers a powerful self-healing response from the body. Why not take advantage of our self-healing powers? A doctor who ignores such powers could inflict even more damage on the body than the original problem. There is even a special term iatrogenic conditions meaning those caused by medical intervention.

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An illness triggers a powerful self-control response from the body to achieve self-healing.

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The healing approach 

The healing approach is based on dialogue with the body. To quote Alexander Alexeichik, a renowned Russian psychotherapist: Attempts to change a live organism by force are often counterproductive: you can only encourage it to change on its own. Indeed, life, health and the body resent forceful changes so much that treatment may sometimes cripple the patient. In this case a short-term recovery would be followed by a general collapse.

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It should take long for self-cure to replace medicine, because of the fear, self-distrust and unnatural physical reliance on drugs.

Sri Aurobindo

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Healing, on the other hand, means recuperation of the body by fostering self-change, self-control and self-regeneration. Self-healing is the start of genuine recovery. The human body knows how to eliminate microscopic inflammation centers and adjust small imbalances at the cell level. During this process, each cell and each organ receive extra nutrition, oxygen and energy needed to restore their functions.

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Healing means recuperation of the body by fostering self-change, self-control