By Dr. Cheryl Yelverton – Margate, Florida – Dr. Cheryl Yelverton specializes in the field of Oncology and worked as a surgeon for many years. She understands this disease from a western and now, from an eastern perspective as well.
The Integration of East and West in the Treatment and Support of Cancer
The integration of traditional Chinese medicine and Western medicine and their clinical effects have been widely evaluated. Studies have shown that using a combination of both traditional Chinese medicine and Western medicine has resulted in better outcomes versus using only one of them.
Acupuncture is a traditional Chinese medical modality, which plays an important role in pain management, functional improvement, overall wellness and prevention.
Acupuncture is currently being utilized in the treatment of cancer patients for pain management, fatigue, hot flashes, reduction of post-operative and chemotherapy-induced side effects and to increase Saliva production in patients suffering from xerostomia (dry mouth) which is commonly experienced by cancer patients following radiation of the head and neck regions.
Acupuncture also alleviated joint pain and stiffness, reduced stress and improved overall physical and mental well-being in patients. Acupuncture is generally safe, painless and well tolerated by patients. It is noted that particular conditions require continuous treatments in order to achieve long-term effect.
Current research available supports the efficacy of acupuncture in the following areas:
- Acupuncture for the treatment of pancreatic cancer pain
- Acupuncture for hot flashes in breast cancer patients
- Acupuncture for post-thoracotomy pain
- Functional Magnetic Resonance Imaging (fMRI) Changes Associated with Salivation following Acupuncture
- Acupuncture for pain and dysfunction after neck dissection, acupuncture for xerostomia (dry mouth)
Further research, education and clinical trials are required to continue the validation and integration of acupuncture and integrative oncology treatments in conjunction with conventional treatments currently available.
POST OPERATIVE PAIN MANAGEMENT:
Acupuncture is most commonly known for its ability to successfully manage and treat pain. Pain is typically an indication, forewarning or a direct result from a problem or condition that exists somewhere in the body. The intensity of the pain (typically measured on a VAS pain scale of 1-10) can usually indicate the severity of the problem and the quality of the pain can also give insight as to the underlying cause of the pain. Typically, Acupuncturists will note two types of pain qualities: “dull and achy” or “sharp and stabbing”.
Dull and achy pain refers to “energy” related pain or qi stagnation; sharp and stabbing pain refers to blood stagnation or stasis (specific acu-points will be utilized depending upon the quality of the pain). Both can be ameliorated with local and distal acupuncture treatments which will stimulate a series of reactions along the pain pathway (the previous mentioned phenomena of improved circulation, reduced inflammation and endorphin release).
By increasing the blood supply to a post operative area and surrounding tissue(s), acupuncture treatments are able to accelerate the recovery process following surgical procedures and provide short term symptomatic pain relief as well as long term chronic pain relief.
Other factors which also have importance in determining the appropriate treatment protocol would be a specific time of day the pain is better or worse, whether the pain is affected with climatic changes, whether the pain better or worse with ice or heat, movement or rest etc.
As noted in a 2004 study by the American Society of Clinical Oncology, Acupuncture for Post chemotherapy Fatigue: A Phase II Study; Generalized fatigue and chronic fatigue symptoms are often experienced by both cancer patients and cancer survivors. Currently, chronic fatigue is not diagnosed with a specific test nor is there a specific treatment available with conventional medicine. Through a differential diagnosis, Acupuncturists are able to determine a syndrome or organ system specific cause of the patients’ symptoms.
The goal of the treatment is to provide the patient with long term relief by addressing the underlying problem and not simply masking the symptom. This is often referred to as treating the “root vs. the branch” or the “core vs. the symptom”. While addressing the patient’s complaint(s) or disorder(s), we want to offer symptomatic relief while working on and addressing the root of the problem or core issue(s) to prevent or decrease the likelihood of the symptoms returning.
Typically in TCM, chronic fatigue symptoms and syndromes stem from a deficiency or weakness of Qi. By utilizing acu-points that specifically regulate the movement of Qi and restoring the healthy circulation of Qi and blood throughout the body, patients are able to feel an overall increase in energy, vitality and general well-being.
POST OPERATIVE AND CHEMOTHERAPY-INDUCED SIDE EFFECTS:
The NIH Consensus Panel on acupuncture in 1997 concluded that there is evidence that acupuncture is effective for adult postoperative and chemotherapy induced nausea and vomiting. Research supports the use of the acupuncture point PC-6 (Neiguan) which is located on the palmar side of the forearm, approximately three fingers above the crease of the wrist, to counteract the adverse flow of Qi which is typically associated with nausea and vomiting.
Acu-pressure can be applied to this point by the patient and is often encouraged during treatment to increase the efficacy of the acupuncture treatments and provide patients with relief on their own.
While multiple acupuncture points can help the overall post-operative and chemotherapy-induced side effects, other variables will determine the specific treatment protocols and selected acupuncture points for each individual patient. Although many patients may present with comparable signs and symptoms, treatments, selected acupuncture points and additional therapies warranted can and will vary based on the differential diagnosis performed by the acupuncturist.
Xerostomia is the condition of abnormal dryness of the mouth due to decreased secretion of saliva or spit to keep the mouth wet. It is a disheartening condition which can significantly impair quality of life in sufferers. As per the National Cancer Institute, Head and neck cancers account for approximately 3 percent of all cancers in the United States and their treatment by radiotherapy gives rise to xerostomia in most cases. Cancer patients typically exhibit a high prevalence of xerostomia. According to a 1999 study, roughly 70% of seriously ill cancer patients suffered from xerostomia.
Studies show a significant increase in saliva both during and after acupuncture treatments which involve manual or electrical stimulation. Patients are typically treated with specific acupuncture protocols involving points to calm the mind, reduce inflammation and hypersensitivity, increase Saliva and additional support to other acu-points based on symptom variables.
Treatments include both body acupuncture and auricular (ear) acupuncture. Acu-pressure treatments may also be included in the patients’ treatment plan as this will allow patients to treat themselves while not in the office in an effort to maximize treatment efficacy and results.
Studies also show improvement with Saliva output in patients that are given sugarless mints during treatment to help stimulate salivary flow, although the mints usually produced little, if any, saliva without the use of acupuncture. In 2011, a randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma showed acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life. Cancer, 118: 3337-3344.
Hot flashes are sudden feelings of warmth, which are usually most intense over the face, neck and chest. Hot flashes are typically a feeling of intense heat with sweating and an increased heart rate or heartbeat and can typically last anywhere from 2-30 minutes.
The sensation of heat usually begins internally and will progress to the surface of the skin, especially on the face which becomes hot to the touch hence the alternative term “hot flush”, which describes the sensation of heat which is often accompanied by visible reddening of the face.
After a hot flash or an episode of profuse sweating, patients may experience a chilled sensation, which in TCM, can be an indication that the body is “fighting” or trying to defend itself. The etiology behind this phenomenon is the patient will have a sensation of heightened or elevated temperature when the body is fighting or trying to balance itself out.
Typically, the body will expend all of its energy essentially depleting its own energy source which leaves the body in a vulnerable and comprised state unable to defend or protect itself thus causing a chilled sensation. This is referred to as chills and fevers and can be compared to the signs and symptoms experienced during the beginning stages of the common cold or flu.
Acupuncture treatments trigger 2 direct measurable responses from the central nervous system. The first is the body’s ability to release a substance called “Cortisol”. Cortisol is the body’s own natural anti-inflammatory (heat clearing) and anti-stress chemical. The second is the body’s ability to stimulate the production of endorphins, which are the body’s natural pain killers and feel good chemicals which also help to stabilize the body’s temperature thus alleviating the hot flash in both an acute and chronic setting.
COURSE OF TREATMENT:
Patients are usually treated once a week and given a Chinese herbal preparation to take between sessions. The number of treatment sessions will vary from patient to patient dependent upon other variables the patient may be dealing with (insomnia, digestive disorders, emotional strains and stressors etc.) In certain instances, patients suffering from xerostomia, an increase in salivary flow can be seen as soon as the first visit and the duration of improvement typically increases as the treatments continue, while other patients may need several treatments to receive an improvement.
The focus of the treatments is to get patients into what is known as the “wellness phase” where the patient’s protocol will be dictated by how the overall patient response is. Meaning, once the patient reaches this wellness phase, if they feel good for 15 days, we want to see them in 15 days, if the patient feels good for 30 days, we want to see the patient in 30 days etc., ultimately coming in for treatments and follow ups for overall maintenance and well being.
For more information about our integrative oncology services available, please call us to schedule an appointment today.
Acupuncture and Cancer Support at CARE Wellness Center – serving the residents of Coral Springs, Margate, Coconut Creek, Tamarac, Parkland and the surrounding cities of Ft. Lauderdale Florida. Please call 954-586-8088 to get started today.
Learn more about Dr. Cheryl Yelverton MD, L Ac, licensed acupuncturist.
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