Keep The Change

This week’s guest columnist is Dr. Hanh-My Tracy Tran, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

It’s shameful getting sent to the principal’s office, so I recall the time it happened to me.  My fourth-grade teacher was worried that I was ill, and then grew more concerned when she noticed red marks and bruises on my neck, back, and shoulders.  When she asked me about them, I said that’s how my mom treats me when I’m sick.  Even more freaked out, she sent me to the principal’s.

My response raised fears of abuse, but to me, a Vietnamese, the practice of “coining” is normal. Known as cao gio (pronounced gow yaw), coining is a common traditional technique in Southeast Asia.  It’s used to treat flu, colds, muscle pain, and fatigue.  The literal translation is “catching the wind.”  It’s believed that we get sick because of being  too much in windy weather, causing an imbalance in the immune system.  To restore balance, ”bad wind” is released from the body by coining.  Objects with smooth edges like coins or spoons are dipped in heated oil and rubbed in a specific pattern on the back, chest, shoulders, and neck.  This leaves red lines that last for 3 to 5 days.

When children come to the Emergency Department, doctor’s offices, or schools with these marks, things can become hectic.  Doctors, teachers, and other parents who aren’t familiar with coining worry about abuse, and think about reporting it to police and the Department of Family and Children’s Services.  All the more reason for doctors to listen to patients and their parents without prejudice.  Physicians must be willing to be open-minded about different practices.  For parents, it can be uncomfortable to discuss alternative medicine with doctors, fearing judgement.

It’s important to discuss alternative practices with doctors, because some can help, but some can be harmful.  Doctors are becoming more aware of these practices, and science is helping to figure out which are actually good, and which might be dangerous.  The National Institutes of Health now has a Center for Complementary and Integrative Medicine (NIH-NCCIH) to study these issues.  Stay tuned!

In these high-tech days with tele-medicine, you can meet your doctor or specialist over the computer. They can see you, discuss your problems, look at labs and xrays together, and have a nurse practitioner do a proxy physical exam .  I know a woman with a low-tech equivalent: she calls up her traiteur, and gets her healing over the phone!

Alternative medicine is ancient.  Wherever there’s people with limited access to health care, lack of understanding of disease, or few resources, they turn to what’s at hand.  In medieval Europe, they used what herbs grew in the forest or garden.  In Asia, they used coining like we discussed above, and other methods like cupping, acupuncture, massages, and their own herbs.

Many of these therapies survive today.  Olympic athletes use high-tech training tools like high-speed filming of their techniques and oxygen/substrate burn measures, but then show up with odd red circles all over them.  In the 2016 Olympics in Rio De Janeiro, Michael Phelps and others used cupping, a centuries-old technique where a cup is heated and applied to the skin.  When the air cools inside the cup, it sucks onto the skin, leaving distinct round bruises. It’s believed that cupping helps muscles recover from fatigue.

Science is just starting to evaluate these practices, to see which really help, and which might be harmful.  For example, St. John’s Wort is a plant that’s been used for centuries for depression, and is available as a dietary supplement.  However, it can interfere with some life-sustaining medications, like prescribed antidepressants, heart medications, chemotherapy, and a host of others.  To get the facts on St. John’s Wort and other dietary supplements, go to the NIH-NCCIH (mentioned above) website for their “Using Dietary Supplements Wisely” fact sheet.  This is especially important when considering supplements for kids, as their ability to handle these can be different than adults.

When you take your child to the doctor, be sure to mention all alternative practices you use.  Some are helpful, some aren’t, and it’s important to know so we can make sure  standard medicine doesn’t interfere with the alternative stuff.  And so when we see odd circles or coining streaks, we don’t panic either!

Alternative Medicine?

The child had odd markings on his back.  He was three years old and being seen in the Emergency Department for coughing.  The resident first examined the boy and noted red streaks up and down his back.  The rash looked like it was drawn on by marker.  Or a branding iron.  Concerned that the child was being physically abused, the resident brought me in to look.

When I saw the marks, I breathed a sigh of relief.  “This isn’t abuse.  This is from ‘coining’,” I explained.  The family was vietnamese, and coining is an asian tradition of heating a coin and rubbing it on the back to draw out the “bad humours” causing the child’s cough.  They were not abusing their child, only trying to make him better.

We occasionally see or hear about alternative practices in the ED, what modern medicine now calls “Complementary and Alternative Medicine,” or CAM.  CAM includes traditional practices like herbology, acupuncture, chiropracty, and in Louisiana, the Traiteur. Surveys show that many more people are using CAM therapies on themselves and their kids than doctors hear about.  People are often uncomfortable telling their doctor about such practices, fearing they will be ridiculed for using what many physicians regard as quackery.

However, the line between “modern” medicine and CAM is starting to blur.  As certain non-medical therapies are shown by science to help patients get better, they have become adopted by modern medicine.  Such therapies include diet modification and probiotics, massage in kids with chronic pain, and play therapy for kids in the hospital.  The NIH now has a research section called the National Center for Complementary and Integrative Medicine, to study the validity of these practices.  The American Academy of Pediatrics also has a Section On Integrative Medicine with the same purpose.  In fact, some doctors get extra training in CAM therapies to ”integrate” CAM into their practice.

Now, some alternative medicine seems down right kooky.  Once in medical school, I was watching a woman in labor.  The Labor and Delivery nurse was an older, experienced, no-nonsense professional.  She took a clear history about the pregancy and competently assessed the contractions and cervical dilation.  But then this all-business nurse said to the woman, “We will need some more positive energy for this delivery,” and began to hover her hands up and down over the patient’s swollen belly, murmuring about boosting energy, acting like a wizard from the movies.  The nurse’s sudden change and what she was doing blew my mind.  Was this really happening, in a real hospital?  Was this Labor and Delivery, or the Psych Ward?

As I reflect on this memory now, I have more sympathy for that nurse.  I pray, go to church, and believe God gives me strength for the many stresses and occasional tragedies in pediatric emergencies.  But Christianity seems kooky to my sister-in-law, who is an athiest.  To her the universe is a machine, needing no diety to run it.  My belief in an unseen God and Holy Spirit is just as silly to her as the Labor nurse’s invoking positive energy with her hands.  However, this illustrates why many people use alternative medicine- it fits their belief systems, they are comfortable with it, and they feel it helps.

As we discussed above, scientific medicine is now researching alternative CAM therapies.  Science is powerful- it has given us antibiotics, cancer cures, anesthesia.  Science also realizes that belief is powerful too, and is testing the limits of what we believe will work and what actually will work.  Science has already revealed the danger of some alternative medicines- St. John’s Wort and chelation therapy in autism, for example. Science has also started to show that traditional practices like acupuncture, chiropracty, and massage may have real therapeutic benefits.

So don’t be afraid to talk about “alternative” therapy with your child’s doctor.  The doctor may already know more about these practices than you think.  Your kid’s doctor needs to know about these, to help counsel you about which practices are safe and which aren’t. However, if your doctor starts passing his hands over your child and murmuring incantations, maybe the doctor has gone too far.








Herbs and Acupuncture: “Real” Medicine?

Sometimes when a parent is talking about her sick child, I hear about things they have already tried to make the kid better.   Usually these are the regular things like pain medicines or hot compresses.  Sometimes parents try things that sound wacky- blowing cigarette smoke in the child’s ear for ear pain, taking the child to a traiteur, or rolling hot coins on the child’s back (for chest congestion).  Many parents are afraid to tell their doctors about such “alternative medicine” practices, for fear that the doctors will fuss at them for not sticking to ”traditional,” science-based medicine.

I try not to be judgemental when parents tell me such things (except for the cigarette smoke- c’mon!).  First, I want parents to feel safe that they can tell me everything I could use to figure out what’s wrong.  Some experts say that as many as one third of all patients use some alternative medicine along with traditional medicine, and I want to hear about it. 

Secondly, I can’t be too judgemental because much of traditional medicine has not actually been tested in a scientific way.  Science examines medicines and therapies by “blinding” the people being treated and the doctors giving the treatment.  In other words, neither doctor nor patient know who is getting the true medicine, or a placebo (fake medicine).  Thus their biases and feelings about whether something will work or not will not sway the results.  Experts figure that only about one third of traditional treatments, medicines, and surgeries have been tested scientifically!

Fortunately, nowadays modern medicine is cleaning house.  A movement  called “evidence-based medicine” is testing all current practices, tossing out those that truly don’t help, and promoting those that do.  Some traditional medicines are being thrown out, like cold medicines.  Other medicine’s uses are being modified, like careful use of antibiotics.  Surgical techniques are being discarded or improved with a more scientific knowledge of their usefulness.

Scientific medicine is also starting to test alternative medicines and practices  like herbs, acupuncture, and chiropracty.  (By the way, many modern medicines are herb-derived, like digoxin (foxglove) and aspirin (willow bark), so what is really traditional versus alternative?)  There is now some evidence that treatments like acupuncture and probiotics may have value.  Other treatments, like St. John’s wort, have been shown to have bad side effects.   Good studies of alternative medicine are just getting started, so stay tuned.

In the mean time, don’t be afraid to talk to your doctor about all treatments you have tried.  Your doctor should be up on the latest about alternative medicine, and be able to guide you about what is safe and effective, what is not, and what we don’t know yet.  One thing is absolutely for certain- cigarette smoke is really, really bad.  Please leave that off your child’s treatment plan!

5/16 Addendum: Red Lerille cornered me today at the gym and asked jokingly, “Hey, what’s wrong with traiteurs?”  I answered, “Absolutely nothing, they can only help!”   I believe in the power of prayer.  In fact, scientists have actually done studies to see if prayer helps make people get better.  The answer: they can’t be certain yet, but maybe!