Facing Cancer (or Whacked Upside the Head by Mainstream Medicine) Part II

For Dia de los Muertos, I extended the “crack” in my forehead and tried to show something hopeful coming from it.

Last time I told you about the existential crisis I had over a small skin cancer that led to a larger surgery than I was expecting and the threat of more slicing and dicing to come. What I thought would be, as my primary care doctor had suggested, a “cure” was no such thing. A real cure would have to involve much more than simply cutting out an individual piece of tissue.

The first order of business was to clean out the inside of my head. I needed to get past the pernicious suggestion that the surgeon had implanted, and believe with as much certainty as possible that I did not have to have any more cancer anywhere. I’ve made good progress on that, I think, but it may be a while before I completely stop hearing his words. As I write, it’s been about three and a half weeks, not really very long to heal either physically or psychologically.

The wound itself is improving steadily. The paresthesia from the damaged nerves has already diminished quite a bit.  The worst part now is the lumpy “dart” at each end of the incision. One is at the hairline so less obvious, but the other is very prominent on my forehead. It will most likely look better later on when I can massage the scar and soften it, as I was told to do by the surgeon’s assistant. The repair job does seem to have been well done in technical terms. At the moment I still feel disfigured, though.

I honestly didn’t realize that I cared that much about my face. I’ve never been particularly beautiful and I never relied on my looks to get me anything, so I wouldn’t have expected to react so strongly, but a facial wound feels like a scar on one’s very identity.

It’s interesting; I almost feel more willing to lose my entire body than to have individual parts chopped away. When I was threatened with a hysterectomy many years ago because of nascent cervical cancer, I fought that idea and insisted on keeping as much of my original equipment as I could, while being told I was crazy by the PCP I had at the time. And miraculously enough, even after two conizations (yet another example of not getting it all the first time) and stitches tearing out and needing an extra repair, my cervix eventually filled itself back in. All that’s left of the damage is a very thin, clean scar with healthy tissue around it. That is what the female body can do. I am holding on to the idea that every body has far more ability to regenerate than we give it credit for.

I was only in my first year of acupuncture school when that intimate surgery was done, and my understanding was more limited than it is now. Although the tissue that was removed was not yet invasive cancer and might never have become so, it was already making me ill. I had unusual, severe, long-lasting infections that year; it seemed that my immune system just couldn’t keep up with holding cancer at bay and fighting microbes as well. I knew something wasn’t right. When the carcinoma in situ was found, I just wanted it to be taken out as soon as possible and give my body a chance to catch up. I remember feeling icky about having that diseased mass inside me, unclean, which was probably not very helpful to the healing process in itself. That part I was willing to lose.

After the second conization, I landed in the ER with heavy bleeding, and lost over a liter of blood by the time the repair was done. I was the pale tongue model in my class for many months after that! The blood loss, combined with the stress and fatigue of school, led to some long-term problems that have not entirely resolved. If I could have known all that would happen, I would probably have tried to avoid the surgery. There might have been another way to reverse the condition. However, at that point it seemed that my body was unable to manage the job on its own. And indeed, I did stop getting sick.

As you most likely realize, cancer starts somewhere in your body over and over throughout your life, triggered by a host of possible factors, but your immune system destroys the errant cells before they can cause trouble. It stands to reason that anything that can increase the efficiency of the immune system is good for preventing cancer, while anything that decreases it— including emotional and psychological issues— can help cancerous cells get a foothold. Not that making use of the immune system is necessarily simple to accomplish. Mainstream medicine is doing a lot with immunotherapy for established cancers, but as people go along years after their treatment, autoimmune conditions like diabetes are showing up, because the immune system went over and above what was necessary to get rid of the cancer. So far we can’t control this treatment very precisely. However, I expect that eventually immunotherapy, using the body’s own methods but amping them up, is going to be the main way we deal with cancer. And that’s what I would consider a real cure, rather than just cutting out the lesion we can see without doing anything about the underlying process.

Let’s think for a minute about what that underlying process is. Most cells undergo apoptosis— after a predetermined number of divisions, they die and make room for new cells. You might think of immortality as a good thing, but cancer is immortality run amok. Cancer cells don’t die when they’re supposed to, but keep reproducing and invading healthy tissue, using up resources without performing necessary functions, and causing obstruction and pressure on other structures. So we need to either kill them or somehow cause them to revert to healthy cells that die as they’re supposed to after a full, productive life.

The thing that we often forget, with our violent rhetoric of “fighting” cancer, is that cancer is no more nor less than our own cells. It is not some horrific, alien invading force. It’s our own cells that for some reason are operating under incorrect instructions. Really, that’s all. All that suffering caused by parts of us.

Which brings me back to cleaning out the inside of one’s head. Ultimately, every disease is psychosomatic, because we are constructing the reality of our bodies from moment to moment. It’s crucial to examine whatever is going on psychologically and emotionally and deal with it as best we can. There is no substitute for that. However, sometimes a cigar is just a cigar, a toxic exposure is just a toxic exposure, and solar radiation is just solar radiation. So many issues can be involved in cancer, and there is no sense indulging in victim-blaming, including blaming ourselves. Our bodies are subjected to the various insults and influences of the physical world, and sometimes, it seems to me, stuff just happens for reasons we can’t understand, and it may not be worth analyzing it to the nth degree, to the point where we start doing ourselves more harm by obsessing. We can go forward and figure out what to do next instead.

I haven’t heard anything from dermatologists about preventing skin cancer other than staying out of the sun and/or using sunscreen. The guy who took out my stitches went as far as to say something like, “Even if you’re only exposed for a short time, like getting into your car, the damage builds up with every drop of sun.”

OK. Let’s just stop right there. I don’t see where paranoia is going to help any aspect of our health. Believing we are being harmed every time light hits the surface of our bodies is incredibly counterproductive. We also have evidence that when everyone started religiously dousing themselves with sunscreen, the rate of colon cancer went up, likely because of depletion of vitamin D. We need sunlight. We just need to be careful with it.

It’s well established that low blood levels of vitamin D are associated with a range of health problems, including a greater risk of cancer and a worse outlook for more severe disease and for recurrence. What is not so clear is whether supplementing vitamin D in established cases of cancer will help cure them. I advise my patients to keep their vitamin D level up, since as far as we know that’s best, and I take it in supplement form myself. Even in sunny New Mexico, blood tests show that a lot of us are seriously deficient, and of course that’s more likely in the winter.

For years I have been referring patients to this website from the UK:
https://www.canceractive.com/
The originator, Chris Woollams, collects every piece of information he can find about cancer treatment and prevention. I don’t always find every bit credible or useful, but overall this is the most comprehensive source of cancer knowledge I’ve seen. It’s also a source of hope. A major recommendation given at this site is the “Rainbow Diet,” the concept of basing one’s diet on colorful vegetables and fruits. Although there are conflicting recommendations about diet for treating and preventing cancer (as for everything else), there is broad agreement about eating whole, unprocessed or minimally processed foods, including lots of vegetables. You can’t go too far wrong that way.

At our house we’ve been breakfasting on green smoothies to get our intake of phytonutrients up, and they are yum. I bet my husband, not a big vegetable fan, would never have expected that he’d enjoy snarfing down blenderized kale and spinach, even with fruit added, but he’s loving it. I’ve noticed a small improvement in my vision, which I think is remarkable after just a week or two of extra carotenoids and such.

There are so many substances that have shown activity against a particular cancer or against cancer in general, and many of them are found in those colorful plant foods. Others are herbs or components of animal-based foods. Each one could be a post or series in itself. Here is a partial list of substances that as far as I know are well-researched:
turmeric
medicinal mushrooms (reishi etc.)
DIM, indole-3 carbinol, and sulphoraphanes, all found in cruciferous vegetables
green tea catechins
fish oil
modified citrus pectin
vitamin C (including topically as a sunscreen ingredient)
vitamin A
astaxanthin (from algae, the pigment that makes flamingoes pink)

A simple and surprisingly effective measure is to take aspirin daily. Even a low dose has been shown to reduce the risk of getting cancer in the first place and of having tumors spread if they have already occurred.

Melatonin seems to have a number of useful effects for cancer patients, including reducing damage from chemotherapy and radiation and helping tamoxifen to work better for breast cancer survivors. It has been shown to lower excess levels of estrogen and IGF-1. Here is a worthwhile discussion of it:
https://www.canceractive.com/cancer-active-page-link.aspx?n=1242


Cannabis is often touted as a cancer cure, but from what I’ve read, the situation is muddled and complex. For some types of cancer, it seems to help, but for others it may make things worse. More research is needed, and if the US government would stop making it so hard to do research with marijuana, we’d likely get it faster! I am using a CBD salve around my incision at the moment because it seems that it may help, and at any rate keeping the scar tissue moist and softened is a good thing.
http://scienceblog.cancerresearchuk.org/2012/07/25/cannabis-cannabinoids-and-cancer-the-evidence-so-far/#.Wfe1EK293b0.facebook

Dairy is another controversial subject. Some authorities state that it encourages the growth of cancer and forbid it. Yet, in the form of cottage cheese, milk protein is a major part of the Budwig diet for cancer patients, which apparently has been of help to some. If I had to give advice on this issue, I would say to use only organic dairy with no hormones given to the cows, grass-fed if possible, and as with any food to pay attention to how you feel when you eat it. Don’t eat anything that you don’t tolerate well. I don’t have any clearer information than that at this moment.

While I was in my first week or so of recovery, the film Cancer Can Be Killed showed up online. It tells the story of the filmmaker’s wife, who had bladder cancer and was given no hope except to have her bladder entirely removed. A relative of hers had gone to Germany and been treated with hyperthermia, and had recovered completely, so she did the same, with an excellent outcome. Hyperthermia is not available in the US except in combination with chemo and radiation, they said. It seems like it ought to be.

The hyperthermia was combined with nutrition and other naturopathic treatment. I don’t think we can argue with the concept of helping the body to be as healthy as possible while trying to get rid of the cancer, no matter how we go about the cancer treatment itself. Mainstream oncology hasn’t tended to do that, to say the least. There were a number of statements made in the film that made my BS meter go off, though. One issue was the insistence that eating sugar feeds cancer. I’d heard that many times, and hadn’t really questioned it, but it’s become clear to me that it’s misleading.

Cancer cells do take up more glucose than others, because they are dividing rapidly, and that fact can be used in PET scanning. However, it does not follow that sugar in the diet increases the growth of cancer. In fact, check this out:
https://www.genengnews.com/gen-news-highlights/cancer-cells-are-what-they-eat-and-it-s-not-glucose/81252451

This does not mean that a cancer patient or anyone else should be eating a lot of concentrated sugar. Insulin resistance and diabetes contribute to cancer as well as other health problems, and excess weight is associated with cancer too. Sensibly reducing or eliminating processed sugar from your diet is healthy. Living in fear that eating a molecule of sugar is going to make your cancer grow, though, not so much. Here’s a good overview:
https://www.oncologynutrition.org/erfc/healthy-nutrition-now/sugar-and-cancer/

I don’t want to do anything, or avoid anything, out of fear. That cannot possibly be the way to health. This afternoon I spent a few minutes standing in the yard with the sun on my face. It felt sooo good— just comfortably warm at this time of year, not overwhelming. I let it sink in and told myself that the sun’s energy was healing my body and soul.

On the website of the clinic that treats with the Budwig diet, I saw a lot of questionable ideas and products, but I also saw this, which seems like the perfect thought to leave you with: “As I emphasize to my patients that come to the Budwig Cancer Center, forgiveness and ‘counting your blessings’ are two of the most important emotional states you need to stay strong. Forgive absolutely everyone that has disappointed you at some time in your life because holding a grudge is too heavy for you to carry and especially at this moment in your life.”

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How to Treat Plantar Fasciitis at Home

This is not my usual type of subject for this blog, but so many people need the information, I’m including it here as well as at my business site, http://elenelistens.com.

I often see patients complaining of heel and sole of foot pain. They may identify it as plantar fasciitis, or they may simply point to the spot that hurts. Most of them have shown the classic pattern, in which they have the most pain on first stepping out of bed in the morning, then feel better for a while, then have more pain again after being on their feet for a long time through the day. So many people have this pain going on that I want to get the word out more generally about how to relieve it, instead of just telling my own patients one at a time.

This common condition usually responds well to self-care, which is crucial whether one is working with a health-care professional or not. Let’s look at what’s going on in the leg and foot and what you can do about it.

The term plantar fasciitis refers to inflammation of the fascia, the connective tissue, in the sole of the foot. (Plantar means anything having to do with the sole of the foot, as in plantar warts, often mismentioned as “planter’s warts.”) Very often, the pain is felt mainly or entirely in the center of the heel. There is a simple reason for this. The Achilles tendon connects with the foot right there, and when the tendon is tight, it pulls on its attachment to the bone, which hurts, sometimes quite a lot. This can affect one or both feet.

Generally speaking, although the pain can feel like you’ve got a rock in your shoe or like there’s a sharp object inside your heel itself, this is not necessarily being caused by a heel spur, which is a growth of extra bone on the calcaneus (heel bone). Heel spurs often cause no symptoms at all, and may or may not exist at the same time as plantar fasciitis. If you do have a heel spur, don’t panic. The usual treatment is the same as what I am describing here, and it is very unlikely that you will need surgery or any kind of drastic intervention.

Why is the pain worse first thing in the morning? During the night, your ankle extends, since you are not putting weight on your foot, and the back of your calf is allowed to shorten (as is the sole of your foot). As soon as you do put weight on the foot, your ankle must flex so that your foot is flat on the floor, which pulls on the back of your calf. The tight muscles and tendon suddenly yank on that attachment at the heel and on the sole of your foot in general. After you walk around a bit and get things loosened up, the discomfort eases. Then, after some hours of weight bearing, your inflamed, upset fascia starts to get more irritated and lets you know. Sitting for long periods may cause a similar effect to lying down overnight.

You can see that a big part of the solution is to open up the tight tissue so that it’s not pulling this way and can let the plantar fascia calm down and heal. If you have this problem, you will probably find distinctly tight, tender knots in your calf muscles and/or above your heel. Podiatrists typically prescribe stretching of the calf, which is good and necessary, but the trouble is that if you stretch aggressively without doing anything to loosen those tight knots first, you will probably just irritate and aggravate the situation more.

So here’s what you need to do: Feel around throughout your calves and ankles for tight areas, which may be exquisitely sore to the touch. When you find them, gently press and massage them. Experiment with the amount of pressure; you need to be firm enough to make a positive change, but you don’t need to torture yourself. Keep at it until the knots release and the spots aren’t so tender. I recommend doing this before you go to sleep and before you get out of bed in the morning, but anytime is OK. For some reason, massage of the calf is virtually never mentioned by podiatrists or in articles on plantar fasciitis, but I find it to be the most important aspect of treatment. You should start feeling improvement pretty quickly, maybe even immediately. You can also massage the soles of your feet themselves.

Heat may be helpful to help the muscles relax. Ice or cold packs may feel good on your feet to reduce inflammation. You may need to rest from your usual activities, especially if sports or excessive standing or walking are causing pain— but you don’t want to be so immobile that you end up with more stiffness and tension. Whatever makes you feel better is fine with me. I treat patients with acupuncture for the knotted muscles and inflammation, and I use microcurrent stimulation on the feet, since needling directly into the sole can be unpleasant. Professional massage, osteopathic manipulation or other manual therapy, or chiropractic could also be useful. Whatever you choose, self-treatment is going to be extremely important.

What caused the calf muscles and Achilles tendon to get so tight to begin with? There could be a number of factors, such as lack of exercise, too much muscle-building exercise without enough attention to flexibility, a previous injury that has led to muscle imbalances, or wearing inappropriate shoes.

Often adding arch support will go a long way toward solving the problem— although an overly intense or rigid arch support, or one that doesn’t fit well, can contribute to causing it, as once happened to me. Try different shoes and different arch supports to see what seems to work best for you. You don’t have to spend a fortune on orthotics to start with; begin with inexpensive store-bought types and see how you do. It’s possible that you will in fact need custom orthotics in the long run, but you don’t need to start there, and if someone tries to sell you on very pricey ones, I suggest that you put them off for now. Also, some people are comfortable with very firm arch support, while others need as much softness as possible to comfort their sensitive soles.

I have seen a couple of cases that didn’t respond to these basic strategies, but they are rare. It may take a number of weeks or even months for the pain to resolve completely, but you should be seeing definite improvement soon. If that doesn’t happen, something else is going on and you will want to look further.

All Healing Is Self-Healing, Part I

A few weeks ago I ranted about one aspect of our dysfunctional medical system, prohibitively high copays. Since then I went to see my chiropractor*, and he mentioned that his patients have been telling him that they would be coming in more often if not for their recently inflated copays. He added that in the past, by this time of year, patients would virtually all have met their deductibles, but now deductibles are so high that 80% of them have not.

What amazes me most is that we are all putting up with this. But then, we’ve learned that we have no power within this system. Many of us have also learned that we don’t have much power over our own health. More than anything, that is what is going to have to change if we are to have any hope of getting health care on a viable and sustainable course.

Last time I gave you a link to a post by my friend James Rolwing, which he began with this crucial statement: “All healing is self-healing.” Please think about that for a moment. Does it sound true to you? Does it have exceptions? Does it feel liberating, or does it make you a little uneasy?

All any of us in health care can do, for any amount of money, is to aid the body’s and the mind’s own natural healing processes. Even in the case of the most drastic interventions, such as a joint replacement or organ transplant, the body must take what has been added and make it work, while repairing the tissue around the new portions. Surgery can remove damaged tissue or stitch it together, sometimes in truly ingenious and astonishing ways, but there is no force on this earth that can heal surgical incisions except the body’s own innate ability. We do what we can, and then we must wait.

But what about drugs, you say. Drugs make direct changes in body functions. Yes, but the body must metabolize and make use of the drugs, and individual bodies do that in individual ways.

When I do acupuncture I am acutely aware of the fact that all I can do with needles is to give signals to the body about what it needs to do to get back into balance. I can use needles to talk to the body through obviously physical means, engendering tiny electrical currents and stimulating the release of substances such as neurotransmitters and hormones, as well as the subtler energetic signaling that medicine understands less clearly. I can ask for increased circulation or for excess fluids to dissipate. I can ask for whatever I care to, but then the body will do exactly what it wants to do and is able to do, no more and no less.

This is not so much a limitation as a gift, though it can be frustrating to find the optimal way to get the body to respond. Most of the effort and cost in American health care goes to dealing with chronic and often very confusing conditions, and there is contention and controversy about how to treat them. If we say that we want people to have access to health care, what exactly do we want them to be able to access? What is our underlying belief system about how to deal with diabetes or fibromyalgia or cardiovascular disease or even simple aging? I think you have a pretty good idea of how things stand in the medical world at present. We do a lot of fixing but not a tremendous amount of healing, lots of sick care but not so much health care.

How do we find a path to health for ourselves as individuals and as a society? How do we take responsibility for our health in concrete ways? We know about fundamentals like nutrition and exercise (though even those are fraught with controversy), which in themselves could transform our lives if we would do what we know we should. There is far more that we can do, at least if we are fortunate enough to have access to the information we need and the openness to make use of it.

Here James outlines two possible ways of thinking about our bodily discomforts:

“Essentially, we have two choices of dealing with a symptom. We can drive it back below the threshold of our awareness (a suppressive approach) or we can participate with it (an expressive approach). With suppression a door is closed, and with expression a whole world opens up.

“Most of what is typically described as healing occurs as the result of suppressive mechanisms. Painkillers and antidepressants are obvious examples, but any type of therapy can employ a suppressive approach. It is often a fear-based strategy, as we unconsciously fear to examine what is underneath the symptom.

“Expressive healing describes the mechanism of self-healing, and views a symptom as an indication that something within us is asking for acknowledgement, most often trapped or repressed feelings and emotions. Relief or resolution occurs as the result of recognizing and giving expression to these underlying sources, because the symptom was only there to point us toward the deeper cause in the first place.”

http://rolwingjames.wordpress.com/2014/04/13/the-intervention-fallacy-part-i-how-it-starts/

While I was working on this post, my right arm and hand were giving me a lot of grief, impossible to ignore, just in time to help me think about how to apply what I was writing about. That was what sent me to the chiropractor. You might wonder why I needed to/chose to do that, since one’s physical structure ought to be able to right itself naturally. In fact, that’s an essential concept in chiropractic, the body’s innate wisdom and healing capacity. Well, I had been doing everything I could come up with on my own, and it wasn’t enough. I was still having disabling pain and dysfunction, and I needed this kind of assistance. (It’s OK to acknowledge that we can’t do everything alone; that’s not abdicating responsibility for oneself.) Getting my bones pushed back into place helped the acute situation quite a bit, though that also brought other aspects of the pattern to light, which I then needed to deal with. I still had to work with the emotional issues that had been stored in that area of my body; that is, I had to do expressive healing. It was very clear that I had to do that, and that the pain would not resolve otherwise. In the midst of it I went for an Alexander Technique session** to get some guidance in releasing the habitual tensions that were feeding into the problem and to help move the stuck emotional content. It all took a lot of time and effort, especially considering that most of it was a matter of simply letting go! I’m doing a great deal better now. Maybe I even know a bit more about how to avoid this in the future.
Here’s a case for you to contemplate:

A patient of mine who is disabled and on Medicare hit the “donut hole” recently.  A drug which has helped immensely with his diabetes will now cost him $295 per month. That will be the case for four months, one third of this year, even though he is insured— all the way till next year. (This would not happen in the same way with private insurance or with Medicaid, only with Medicare.) His family makes $1000 per year too much to get any kind of extra subsidy. He’ll never get out of the donut hole, because he won’t be able to pay out of pocket up to the amount where coverage would kick in again. They might as well ask him for $2950 per month— he simply can’t afford that $295. He’s already tried the other available medications, some of which are cheaper, and this one worked tremendously better. I could see a marked difference in his condition with it, and I’m sure his PCP was delighted to see what it was doing. So much for that.

If complications from his diabetes put him in the hospital for even one day, that will cost us all more than we would pay to cover his medication for the rest of the year. Our country is being financially stupid as well as cruel to this man. And our vaunted medical breakthroughs are meaningless if our doctors can’t get them to the patients.

This gentleman is a superb energy healer himself, and he does everything as naturally as he can to take care of himself. He has had some success in the past with herbs to control his troublesome symptoms, and he is exploring herbal options again. After a period of being enraged with the system, he decided that the present situation might be an opportunity to find a better way to deal with his blood sugar. At least, he pointed out, he won’t have to worry about the potential side effects of the drug. He already does all the obvious things with diet and exercise, you understand, and with his mental attitude. We’ll see what else he and I can come up with.

Update!!!  My patient has been able to get his meds through a free sample program at Presbyterian.  It took quite a while before this happened, and when he first (and second and third) inquired he wasn’t told this was possible, but the system did come through for him.  He was already developing preventable problems while waiting, however.

 

*Terence Timm, DC. I’d refer you to him except that (waaahhh!) he is retiring very soon.
** with Karen DeWig. http://alexanderabq.wordpress.com/

It’s Mainly Medical, Not Moral

I’m told that this was a real sign, no longer in use, at a hospital in Buckinghamshire, England. I couldn’t resist adding it here– it’s so painfully appropriate to our current situation in the US.

You’re probably sick of hearing about the war over insurance coverage for contraception under the Affordable Care Act, but I think I have a few useful points to make that haven’t been brought up elsewhere.

For those of you who live elsewhere, let me catch you up on this only-in-America craziness.  The Affordable Care Act, otherwise known as the health care reform law, mandates that contraception must be covered by insurers without co-pays (direct costs at the time of service) to the patient, and that employee health plans must provide this coverage.  While there is an exception for employees of churches and other places of worship, hospitals, universities, and other institutions owned by religious sects are included in this mandate.  A number of right-wing forces have complained that this tramples upon religious freedom.  After being thoroughly raked over the coals, the President and his advisors worked out a compromise: the religious groups would not have to pay for the coverage, and it would be provided directly by the insurance companies, so that those who object could keep their sense of purity.  Insurers have agreed to this because providing contraception saves them money (and is expected to save money for the entire health-care system as well as for individual families).  The war is still raging as I write this, with the self-styled guardians of freedom insisting that the government is still overstepping its bounds.

On the front lines of this trumped-up battle, we find none other than the Conference of Catholic Bishops, the same fine folks who protected us from the evil, dangerous practice of Reiki by banning it in all Catholic hospitals and other institutions.  (See my post “Attack of the Bishops.”)  Need I state the obvious?  These ideas are being promulgated largely by partnerless elderly men.  These are not people who have any need to prevent pregnancy or any understanding of what that issue is like for those who do, including the 98% of Catholic women who use birth control at some point in their lives.  This outrage is compounded by the fact that Viagra is covered and the bishops have no problem with that.

A letter I wrote about this recently was published in the Albuquerque Journal on Sunday 2/12/12, before the President backpedaled, and before Rep. Darrell Issa convened a panel of ALL MALE religious leaders, Catholic and otherwise, to testify before Congress.  Issa and his Religious Right cohorts have managed to make it crystal clear that their agenda has little or nothing to do with religious freedom, and is really about a) attacking the president and killing the Affordable Care Act any way they can, and b) controlling women.  They’ve abundantly shown that they want to get rid of not only abortion but all forms of contraception.  And while wailing about the government infringing upon their freedom, they’ve shown that they have no problem with curtailing the freedom of others– especially if those others happen to have pairs of X chromosomes.

Here’s my letter:

“In all the indignation-filled rants I’ve heard about the Obama administration requiring religious institutions to include contraception in employees’ health insurance coverage, there has been one glaring omission:  No one has mentioned the fact that quite often, hormonal contraceptives (the Pill, patches, or implants) are used for medical reasons that have nothing to do with birth control.    Many women take the Pill, etc. for conditions like polycystic ovary syndrome or severely painful periods.  Many of those women are not even sexually active, or not sexually active with men.  I’ve seen this quite a bit with my own patients.  Whatever one thinks about contraception, it’s hard to imagine even the staunchest Catholic objecting to legitimate medical treatment for such conditions.

“I’d just as soon see women use natural alternatives, but in many cases hormonal birth control really changes their lives for the better.  The costs of these medications can be quite substantial, however, and that can put them out of reach for students and low-paid workers.  The costs of the conditions they treat can be substantial, too, as when a woman must miss work because of debilitating pain.  We would not ask an employee to forgo painkillers for arthritis or inhalers for asthma.  How is this different?

“The President may have lost some votes with this decision, but there are quite a few of us who are relieved to see him standing up for women and for what makes medical sense.  Try as I might, I can’t see this as primarily an issue of religious freedom or of morality.  Women who object to contraceptives are still free not to use them.  Morality means doing the best we can for everyone in our society, and that includes medical care, which includes birth control.”

I didn’t want to get all confessional in the newspaper, and I wanted to focus on a single point for impact, without bringing in other aspects of the situation, but I have a personal story that I think sheds particular light on the complexity of this issue and the reasons a total ban by religious “authorities” is not only ludicrous but cruel.

When I was about 25, I developed severe cervical dysplasia, well on the way toward cancer.  This was treated with cryosurgery to remove the diseased cells, which was a standard treatment back then; no one realized at the time that cryosurgery would only mask the problem, which would resurface later on.  My primary care doctor told me I should have a hysterectomy, which showed a remarkable ignorance on his part, it seemed to me, as the precancerous cells were not invasive and might never be.  I had not yet had a child, and was determined to be able to do so.  After I healed from the cryosurgery, I did get pregnant, and my daughter was born when I was 27.  Over the next couple of years I became allergic to or unable to tolerate most forms of birth control, and so, with my husband and my very small daughter in agreement (Lenore’s opinion was “We have enough babies around”), I had a tubal ligation.  Which was covered by insurance, by the way, because my husband is one of those awful, greedy public employees, a teacher that is, and he gets all those totally undeserved benefits.

That was not the end of the medical story.  I had a number of years of clear Pap smears, then skipped a year, because it didn’t seem critical to have one at that point.  The next Pap showed carcinoma in situ.  The tissue underneath the layer affected by the cryosurgery had been stealthily developing toward cancer the whole time, and it had simply taken that long to show up on the surface.  By that time, most of my cervix consisted of abnormal cells, and I was noticeably ill.  To deal with this, my OB-GYN did a cone biopsy to remove all that– they use the word “biopsy,” since it does have a diagnostic aspect, but it’s a far larger matter than the word suggests.

The hospital personnel wanted to do a pregnancy test.  I explained that I’d had my tubes tied.  They impressed on me repeatedly that after this procedure my cervix could not support a pregnancy, and that I needed to be OK with that.  I reassured them again, and the surgery was done.  The pathologist found that there were still diseased cells around the edges of the cone, so a few months later I went through the whole thing again, nearly bleeding to death afterward, and ending up with even less of a cervix.  I emerged from the process weakened but cancer-free.

I often thought about what would happen if a woman in this condition did get pregnant.  Surely it has happened many times.  An embryo would start to grow, everything going fine, and at some point it would lose its moorings in its mother’s womb and essentially fall to its death.  I wondered how far developed the poor creature would be when that happened.  It seems horribly sad, doesn’t it?  The child would be doomed from the start.  The mother would suffer both mentally and physically for nothing.  And all of that could be prevented with the use of reliable contraception, or with my chosen option, sterilization.  If it could not be prevented for some reason, it seems very clear to me that abortion would be a far kinder choice than allowing the baby to keep growing until its inevitable demise, possibly till it could begin to feel something, and certainly exposing the mother to greater risks and discomforts.

I have always wondered how very observant Catholics would find their way through this dilemma, since there would be no way to avoid pain and tragedy, only to minimize it.*  The Church’s official stance, I suppose, would be simply “Don’t have sex.”  Ever again, or at least not until menopause, so that such a tragic pregnancy could never get started.

And of course there are also medical situations where pregnancy would be life-threatening or seriously health-threatening for the mother.  These women need their contraception to be as effective as possible, and depriving them of it verges on criminality, I would say.  Birth control advocates tend to mean hormonal drugs when they speak of “effective” contraception, and that has been the focus of much of the fighting.  I certainly think women should have access to these medications, but I don’t want to come across as a wholehearted fan of the Pill and its cousins.  The Pill, patch, and implant can be problematic for many women, and they can have dangerous side effects, especially as women age.

A friend of mine who cannot use these drugs was put in a ludicrous position by our local Presbyterian Health Plan, on purely ideological rather than medical grounds.  Having been unable to tolerate the type of IUD that releases hormones into the body, she and her doctor decided that she should try the old-fashioned, non-hormonal IUD.  Presbyterian refused to cover that, saying that it’s an abortifacient rather than a contraceptive, and therefore not morally acceptable.**  They were happy to cover the hormonal IUD, which they insisted my friend should use despite the fact that it was already proven to be unsuitable and harmful for her.  The patient’s medical needs meant absolutely nothing.  Let me repeat that, because this is how our system works, and we need to be clear about it:  The patient’s medical needs meant absolutely nothing.  Her own beliefs and moral convictions also meant absolutely nothing.  Fortunately, although she was a college student doing low-paid restaurant work, this young woman was able to get the money together to pay for the IUD herself.

And that is what we face when religion, and only some people’s religion at that, is allowed to determine our medical care.  If the bills currently being proposed by certain members of Congress were to become law, any employer could refuse to cover any type of treatment for any reason.  I don’t think that will come to pass, but stranger things have happened, and we need to stay on top of this situation.  I can only hope that American women will continue to get more and more engaged and will work to hold the ground we’ve gained– and that men have gained along with us– over the past few decades.

I promise to get back to more spiritual matters in my next post.

*Despite 12 years of Catholic school and being good friends with a nun, I still can’t answer this.  Odd situations like this never came up in the typical anti-abortion rhetoric.  And by the way, I don’t remember Catholics railing against birth control back in the ’70s the way it’s happening now.  Maybe I just didn’t notice.

**The common scientific view is that pregnancy begins with implantation, not with conception.  The IUD prevents implantation.

For some other current perspectives:

http://msmagazine.com/blog/blog/2012/02/13/hervotes-americas-supposed-war-on-religion-and-the-actual-war-on-birth-control/

http://msmagazine.com/blog/blog/2012/02/14/conservative-war-on-contraception-is-nothing-new/

 

 

Preventive Care, Personal Responsibility, and $$

Originally posted August 18, 2009

Last week the president made some comments about the fact that the American health care system pays for treatments that may be unnecessary, such as certain surgeries, while it fails to pay doctors to educate patients and perhaps avoid these procedures.  Many MDs were upset by these words, which may not have been chosen in the most politic matter.  Their feelings were hurt, and they protested hotly.  However, this point needed to be made, and as a society we need to discuss it.

Mr. Obama mentioned tonsillectomies as a potentially unnecessary surgery, and your article appropriately pointed out that in some areas of the country far more of the kids have them than in other areas.  It’s obvious that medical necessity is not the only factor controlling this.  A doctor’s medical judgment might be influenced heavily not only by economic factors but by what habits and traditions are common in that time and place.  When I went to acupuncture school, I was the only student who still had tonsils, out of a group of 20 adults ranging from their 20s to their 50s.  Tonsillectomies used to be more common, as far as I know, and that was because doctors and parents believed that they were a good idea, not because they were always necessary.  Similarly, when I took cadaver lab, the instructor was overjoyed to find that our cadaver had a uterus.  He almost never saw one that did.  Hysterectomies were done far, far too often, sometimes by doctors who were known to be “knife-happy,” as my mother’s generation put it.

Thankfully, both doctors and patients seem to be a bit more cautious with these surgeries nowadays.  However, it is absolutely true that doctors generally get paid for doing something, not for helping a patient avoid procedures or medications.  We are famously told that in ancient China, doctors were expected to keep people well; the lowest form of physician was the one who treated illnesses, and the highest was the kind who taught people to live in a way that kept them healthy.  If too many people got sick, the local doctor might be in big trouble!  That is the tradition in which I was trained, yet I too am paid for the treatments I provide, not for teaching a patient skills which may allow them to stop needing treatment.

We give a great deal of lip service to preventive medicine, yet we hardly practice it at all.  HMO, you may remember, means “health maintenance organization,” and the HMOs were originally supposed to save us money by emphasizing preventive care.  Well, we know how that turned out.  HMOs do pay for a certain amount of screening, but they also typically disallow care that is considered “maintenance.”  That is, if you have acute back pain, you are covered, but if you’ve gotten better and you want to see your chiropractor or acupuncturist or physical therapist to keep you from becoming disabled again, your insurer isn’t going to be interested in paying.  Programs that have shown success in improving the health of diabetics by providing people they can talk with about diet and other issues of daily management of their condition have often had their funding cut.

Charles Krauthammer, in a column printed last Saturday, argued that preventive medicine is not the “magic bullet” to reduce health care costs.  “The idea that prevention is somehow intrinsically different from treatment– that treatment increases costs and prevention lowers them– is simply nonsense.”  Yes, this is true if you accept Dr. Krauthammer’s definition of prevention.  “Preventing a heart attack with statins or breast cancer with mammograms is costly,” he writes.  Excuse me? Statins, which do not address most of the mechanisms behind heart attacks at all, and which deplete the body’s stores of CoQ10, thereby contributing to heart failure (not to mention the other side effects), are indeed expensive, but they aren’t nearly as useful as their manufacturers would like us to think.  And no one expects mammograms to prevent breast cancer.  Mammograms can only detect cancers that have already occurred.  This is still a good thing, but it is not prevention.  Prevention is more complicated, and requires more responsibility, than just showing up for a test.

Most real preventive care comes from the patient, from us as individuals, and costs little or nothing.  Improving our diets, for example, is perhaps the single most important thing we could do to improve the health of the entire country, and it would reduce the costs associated with obesity, diabetes, cancer, and heart disease.  For example, if Americans were simply to stop guzzling the incredible amounts of high-fructose-corn-syrup-filled sodas that we consume, we’d make big inroads on diabetes and osteoporosis even without making any other changes.  Most of our chronic and degenerative diseases are caused by our own behavior, and only we as individuals can control that.

There is so much more that could be said here about the ways in which we make ourselves sick by pouring toxins into our bodies and our environment.  Then there is all the illness caused by well-meaning but wrong-headed medical treatment, including the thousands of people who die because of prescription drugs each year, and the harm done by incompetence and poor procedures, like hospital-caused infections.  Much of the care we pay through the nose for is to fix problems caused by the carelessness and stupidity of human beings as a group.  Humans are probably not going to get a lot smarter or more sensible anytime soon, but we can certainly tighten up things like infection control.

What’s being proposed to reform health insurance is hard enough, but real reform of the health care system will require changing our habits and our attitudes– a feat which people usually try their best to avoid.  It’s not easy to feel optimistic about that.  Yet, we must.