Tuesday, March 6, 2012

Are Diagnostic Scans Killing You?

We came to Houston Sunday for Jim’s scans—the first since November when he was declared to be in full remission from stage IV lung cancer. The scan was to be a combined CT/PET. At least that is what we expected. But when Jim reported for the scan early Monday morning, the radiologist informed him that they would only be doing a PET—to be followed by a CT scan if anything lights up on the PET.

Obviously, the doctors are concerned about the excessive amount of cumulative radiation exposure Jim has incurred over the past nine years. I don’t have a precise number but I would be safe to say he has had 30 PET scans, 30 CT scans, 10 chest X-rays, 8 bone scans plus CT guided surgeries, and therapeutic high dose radiotherapy. It’s a wonder he is allowed to pass through airports! Initially no one thought he would live long enough to experience problems from the multitude of diagnostic tests and therapeutic procedures he has endured. But, he surprised them.

All of this got me thinking—and subsequently researching. How many scans are too many? What risks are involved? Do the benefits outweigh the risks?

Most diagnostic tests use a form of radiant energy. X-rays have been around since 1895 when Wilhelm Conrad Röntgen accidentally discovered that cathode rays penetrated many kinds of matter. He took a picture of his wife’s hand and was amazed to see the clear image of her bones. His study led to the discovery of a new kind of electromagnetic wave which he called the “X-ray.”

At about the same time, scientists in other parts of Europe were working with other forms of penetrating radiation. The implications of these discoveries for the medical field were immediately apparent. What was not immediately apparent was the risk involved with prolonged exposure. Marie Curie whose work with uranium led to the discovery of radium and polonium died of pernicious anemia—more than likely a result of repeated exposure to the radioactive materials.

The risks inherent in the chemical structure of these elements present the same problems for us in the twenty first century.

We are exposed to radiation in every day living. In fact, you might say we are showered with it. The amount depends in part on where one lives and how much sun exposure one receives. The average exposure from natural sources is thought to be between 2 and 3 mSv per year. (An mSv is a measure of radiation--the effective dose or risk averaged over the entire body.) This is an oversimplification but gives us a comparison point for the ensuing discussion of exposure from tests and procedures.

One chest X-ray is equivalent to the amount of naturally occurring radiation one would absorb over a ten 10 day period. In other words, it is negligible.

But what about a CAT scan? I was surprised to learn that the radiation from a CAT scan of the abdomen and pelvis is equivalent to five years of naturally occurring radiation. If done with contrast—ten years!

Tomorrow I will discuss the risks verses benefits of routine testing.

Saturday, March 3, 2012

Confucius say: Don't throw out baby with bathwater.

If you read my last post, Chinese Medicine: Panacea or Poppycock, you might conclude that I fall into the Poppycock camp. I don’t. But neither do I belong the Panacea camp. It is difficult for me to accept a mode of treatment which is not based on the anatomical structure of the human body. However, I concede that some aspects of Traditional Chinese medicine are helpful in certain situations even if I can’t accept the theories and philosophies on which they are based.

For example, Qigong, a “TCM system of exercise and meditation that combines regulated breathing, slow movement, and focused awareness” undoubtedly helps with relaxation, flexibility, and strength whether or not it controls the flow of “chi.” The gentle exercise probably does not have a direct effect on cancer, but it does effect the overall well being of the patient—possibly even boosting the immune system. Should you try it? Why not? Can’t do any harm.

There is emerging clinical evidence that acupuncture is effective in alleviating some medical conditions—side effects of chemotherapy, osteoarthritis, migraines, depression, and many other pain related symptoms. Because acupuncture has been deemed safe and without complications, I wouldn’t hesitate to try it for pain control. However, it is not a cure for the underlying condition.

Tui Na is a form of massage akin to acupressure (from which shiatsu evolved). Oriental massage is typically administered with the patient fully clothed, without the application of grease or oils. Choreography often involves thumb presses, rubbing, percussion, and stretches.” Again, I see no reason not to try this form of gentle massage. You don’t have to understand how it works to enjoy the benefits.

“Regarding Traditional Chinese herbal therapy, only a few trials of adequate methodology exist and its effectiveness therefore remains poorly documented.” Some of the herbs used in Chinese medicine are probably effective. No surprise, since many of our modern medicines are made from herbs. The problem with using herbs is in quality and quantity control. I have, in the past, taken herbs for energy, general well being, and minor health concerns, but I am always aware that they are not to be taken carelessly. Over the years I have tried the “herb a la mode” including cats claw, goldenseal, echinacea, ginkgo biloba, arnica, and a host of others. I no longer take herbs because I didn’t see any difference when taking them and, frankly, I got tired of taking (and paying for) so many supplements. I would not recommend herbal medicines for anyone with a serious disease.

Chinese food therapy according to Wikipedia is a practice in the belief of healing through the use of natural foods instead of medications. The underlying idea behind this practice is the balance of energy, Yin and Yang, through the use of “hot” and “cold” foods. This has nothing to do with temperature but rather the very essence of the food ingested. Who can deny the nutritional benefits of onion, garlic, ginger, tomato, mushrooms, and cucumber? But if my health practitioner asked me to eat a bird’s nest (that is the literal nest of a bird not the yummy noodle dish served in Chinese restaurants) or swallow broth made of duck gizzards, I don’t think I’d partake. Nor would I intentionally ingest ear wax, toe nails, or dandruff. But then “Chacun son gout” or “‘Everybody to their own notion,’ said the old lady when she kissed the cow.”

In my opinion, which is supported by controlled studies, the afore mentioned modalities of Traditional Chinese Medicine are harmless and possibly helpful in treating some medical conditions or or symptoms. I would not use them instead of conventional medicine for the treatment of cancer but would consider them as complements to a physician- directed cancer protocol. If you are a caregiver trying to reduce stress and maintain your health, you might consider these treatments.