Turning Point Acupuncture
Email Newsletter Summer 2003
Volume 4 Number 3
Dear Friends and Colleagues,
I write this newsletter while recuperating from the total hip replacement surgery I had last month. The good news is that I am having a remarkable recovery, in part due to all the good preparation I did prior to surgery. Much credit must go also to the Turning Point Acupuncture staff, who have been treating me almost daily starting in the hospital!
In the letter that follows I will tell my story for all who are curious about the details. But more than that, I will describe my experience from my unique perspective as a Western trained physician who has been committed to practicing alternative medicine in general, and Traditional Chinese Medicine (TCM) in particular, for more than two decades. By exploring how my background informed my choice of this radical form of treatment, I hope to share some helpful lessons about dealing with both difficult major health care choices, as well as the countless smaller ones we all make everyday.
At the heart of this exploration is the truth that making any of these decisions determines our quality of life. You will see that my affinity to Chinese medicine is precisely this characteristic: the practice of TCM, especially as applied to the special problems of urban living, can improve the enjoyment of daily living.
Please freely share this newsletter with anyone who can benefit from my experience.
Topics:
1. From Traditional Chinese Medicine (TCM) to Major Surgery
2. Dr. R’s Story: My Left Hip
3. The Yin and Yang of Athletic Excellence
4. When Western Medicine is Inevitable…
5. Hip Replacement Options
6. Dancer's Hip Page
7. Holistic Treatment Options for Osteoarthritis
8. Surgical diary
9 Practitioner References
10. Turning Point News and Summer Schedule
The topics in italics are either too long or of limited interest for the newsletter format. For these I will refer the reader to the appropriate web pages I have made to provide in-depth coverage.
1. Traditional Chinese Medicine (TCM) and my decision to have major surgery:
One of the compelling reasons I was drawn to practice TCM, despite having been trained in Western Medicine, is its focus on wellness and quality of life. Western Medicine is so often directed to diagnosing and treating a set of symptoms in an attempt to “fix” the problem. As such Western Medicine can be terrific in trauma and other emergency situations. TCM is about harmony and balance. Using acupuncture and herbs we balance the body’s life force energy (Qi), cleanse and tone the internal organs and optimize fluids (blood, lymph, etc.). The end result is to potentiate the individual’s health at any point in that person’s life so that he/she can enjoy the highest quality of life. Our toxic urban environment and the difficult political climate we live in pose significant obstacles for optimal health. TCM is a wonderful tool to mitigate the forces that stand in the way of wellness.
The decision to have my hip replacement finally made sense to me when it became about improving the quality of my life. I had explored every possible avenue to avoid surgery, both out of fear and because as a healthy middle aged person, it is very likely that I will outlive my new hip. So delaying the surgery seemed reasonable. I had spent 5 years taking non-steroidal anti-inflammatory drugs (NSAID) daily to sustain mobility and decrease discomfort. I worried about the long-term consequences of medication and tolerated the digestive discomfort. Eventually I developed pain in my back and neck as compensation for my diseased hip, warning signs that I could no longer ignore what had to be done. Once it became clear that my hip pain had begun to substantially interfere with my day-to-day joy of living, I opted for surgery . I was not able to walk more than several blocks without pain and, most importantly, I could not longer express myself physically through dance or yoga.
2. Dr. R’s Story: MY LEFT HIP
Here I tell the story of my life as a dancer and how it ultimately affected my hip.
http://www.dancerhips.com/story.html
3. The Yin and Yang of Athletic Excellence
I have always pursued perfection in highly competitive fields. In these pursuits, despite my extensive knowledge of healing modalities, I did not listen to my body. I rarely got enough rest; I persisted in routinely doing what I had always done despite nagging injury (tendonitis, etc). I never honestly considered finding gentler ways to achieve the same goals. I used the knowledge I had to keep patching myself up to remain in the forefront of my chosen endeavor.
As I get older I have much more respect for the power of Yin energy in our life to promote radiant health. Being a Type A personality is all about Yang energy, the energy valued in our urban culture: doing, making, going, bigger, faster, harder, brighter, etc. But in TCM we know that if that is not balanced by Yin activity, i.e., rest, nourishment, contemplation, reflection, cooler, softer, etc., we get depleted and the body sustains injury. One example of this in our society is how many women in mid-life suffer menopausal symptoms. This is a reflection of a lack of balance in our lifestyle.
To develop this theme specifically about sports (dance) injury from a TCM point of view, we can look at two organ systems:
1. Liver
The liver is an organ system injured by stress. We can think of stress in two ways: emotionally, as in situations that elicit anger, resentment and frustration, and physically, as in the over-use of body parts. The liver rules the tendons and ligaments. Thus any stress to the liver organ system, can result in a disharmony that manifests as injuries like rotator cuff, tennis elbow, plantar fasciitis, etc.
2. Kidney
The kidney organ system rules the bones. The kidney is depleted by exhaustion and fear (and other situations that produce a hyper-adrenalized state). Pushing oneself to physical extremes is typical of the athlete in our culture. More is better is the axiom. In fact the reverse is often true. Over time a repeated injury to the kidney organ system can result in arthritis. This phenomenon is played out daily in the sports pages of the newspapers. Venus Williams played the Wimbledon final despite an abdominal strain and Tyler Hamilton continued to race in the Tour De France with a broken collarbone. Our aging sports heroes (Joe Namath, Jack Nicklaus , etc.) are riddled with degenerative joint disease.
It has been a hard earned lesson for me but I know that all athletic people, regardless of age, need a proper diet, rest and bodywork treatment (to insure free flow of Qi and proper structural alignment going into activity). We can’t just wear down our joints. Joint replacement surgery is a poor long-term solution. The prosthetic joint is never as good as the one God made, to quote my orthopedic surgeon! The prosthesis has a limited life span and the range of motion of the joint may be limited. I will never be able to put my feet in ballet’s fifth position again. There are some activities that are discouraged with prosthetic joints, e.g. jumping. Not to mention the usual risks, infection, blood clots, etc., that attend major surgery.
So here are the current goals for my competitive, athletic self:
To have more balance in my life style, by which I mean to honor the Yin with rest, pranayama (yoga breathing exercises) and meditation. As I regain my physical mobility I hope to develop a healthy and joyful physical practice. One that sustains me and not vice versa!
4. When Western Medicine is inevitable…
Of course there are some circumstances, like my own, in which Western Medical intervention is vital and wholly recommended. Here are some examples:
I have a friend, a non-smoking, athletic woman in her late 30’s who had a heart attack in a stressful situation. She was in cardiac intensive care and then cardiac rehab. She continues to take Western medication.
Another friend developed thyroid cancer and had to have the whole gland removed and is now on life-long thyroid replacement therapy.
And in my practice I have numerous HIV+ individuals on anti-viral medication, Cancer patients on chemotherapy, people with high cholesterol on lipid lowering meds (note: they all need to supplement with Co-enzyme Q 10) and others who have Insulin dependent diabetes.
The point I want to make is that in all these examples, the fact that Western treatment is necessary is a reason to intensify in the area of holistic health care. It is not an excuse to say "why bother?" Just because my holistic interventions did not save me from a hip replacement in the end does not mean I abandon the care of my other joints, nor indeed the new bionic one. On the contrary, I am doing everything I can think of to help my body heal and stay strong.
We need to support the body in its struggle for health at the energetic, cellular, nutritional and structural level by using the amazing health resources available to us in New York City. Even if we have to use Western medication or surgical procedures, the result of adding complementary modalities may mean we will have a better outcome, such as there will be fewer side effects from medication, more successful surgeries, less deterioration of other joints, less likelihood of another episode, that the body will be stronger to fight infection, etc.
As a practitioner of TCM I feel that it should be a critical component of everyone’s health regime: The beauty of TCM is that it can be applied in most circumstances to help bring the body into balance and promote health.
If radiant health is a birthright, then we have the life long mission to support that gift in all the ways that we know and can afford.
5. Hip Replacement Options
The choices to be made about hip replacement surgery are many, especially for the younger patient.
http://www.dancerhips.com/thr.html
6. Dancer's hip page
Issues and inspiration specific to a dancer's recovery
http://www.dancerhips.com/dancers.html
7. Holistic Treatment Options for Osteoarthritis
Options to try for aging and challenged joints
http://www.dancerhips.com/oa.html
8. Surgical diary: Dr. R’s Total Hip Replacement
The surgery took place on June 19th at the Hospital for Special Surgery, a hospital of impressive utilitarian efficiency but totally lacking in spiritual comfort. HSS does 3000 joint replacements a year of which 2000 are hips. The youngest patient last year was 11 years of age. The oldest was 96 years old.
One week prior to the surgery all candidates have to attend a 1-½ hour class about every aspect of the hospital stay. We were given a detailed instruction book and video about the tasks of daily living during the weeks after surgery. We donated blood to be used in surgery , were x-rayed and examined by the internist.
Dr. Douglas Padgett is my orthopedic surgeon and is widely recognized for his interest in the joint problems of dancers.
http://www.hss.edu/htdoc/physicians/physician_biographies/padgett.asp
Prior to going into the operating room, he came to see me and autographed my left hip right where he planned to make his incision!
After making a 5-inch posterolateral incision, Dr. Padgett performed a minimally invasive total hip replacement procedure. The ball and the neck of the femur were removed and replaced with an artificial ”ball-in-socket” joint. The strong stomach can watch a similar procedure on the Internet at either of these sites:
http://www.minitotalhip.com/webpages/Video.htm
http://orthopaedics.hss.edu/ (click on the link in the lower left called Mini Incision for Hip Surgery)
Of the many options for replacement material we settled on highly crossed-linked polyethylene on a metal ball; the stem was tight fitted and un-cemented into the femur.
See this web page for details of surgical options:
http://www.dancerhips.com/thr.html
We used epidural anesthesia with sedation to reduce post-op pain and decrease bleeding in surgery. I was transfused one unit of blood (that I had donated the previous week). After surgery the epidural catheter was left in place and a pump delivered pain medication through it. I was never in pain after the surgery. I was, however quite sick from the post-op meds, to which I responded with very low blood pressure and nausea. It took a full day for the staff to identify why I was so sick. As soon as the pump was stopped I really improved. Since the third day I have never needed more than Tylenol to manage the post-op discomfort. As soon as I felt better I was able to stand using a walker with my full weight on my operated leg. After that my recovery accelerated. I started to have acupuncture in my room that day. The next day I did laps around the ward on the walker and the fifth day I went home with a cane.
At home I was instructed to take iron and aspirin as an anticoagulant for six weeks. I am currently on hip restrictions, which means I can’t stress the healing hip by bending the leg past 90 degrees, crossing my legs or rotating the operated leg inward. I sit in an elevated chair everywhere.
The first week I was visited by a physical therapist assigned from the Visiting Nurse Service. She was very helpful in teaching me to walk outside with the cane. The visiting nurse removed the staples on day #12. Thereafter Chris Bratton, my physical therapist (formerly of West Side Dance Physical Therapy), took over my rehabilitation. I was fortunate to have had Chris in the operating room. Observing the surgery informed rehabilitation choices we would make later in my recovery.
I have been most fortunate to have almost daily body work from the Turning Point staff including acupuncture, Tui Na, foot reflexology and Reiki (they are all so talented!) Roxlyn Moret, my yoga therapist for the past year, is continuing to do Bonnie Bainridge Cohen bodywork (see practitioner list for details).
I am walking as much as tolerated everyday out of doors. Today I walked 40 blocks, stopping along the way for a decaffeinated café con leche on Amsterdam Avenue. Weight bearing is supposed to help the bone regrow around the metal shaft in my femur.
This is the saga so far. It is definitely a day at a time process, but also a wonderful learning experience.
9. Practitioner References
For a list of practitioners I have seen in this journey (and their contact information) use this link:
http://www.dancerhips.com/ref.html
10. Turning Point News and Summer Schedule:
We are glad to welcome back our office manager Deborah Pannell from maternity leave. She and her son are both doing well.
Three new practitioners have recently joined our staff, and we have thus been able to expand our hours to provide several more early morning and late evening appointments. Our senior acupuncturist, E. Shane Hoffman, will be providing most of the treatments Tuesday, Wednesday and Thursday. Although I will not be doing treatment most of the summer, I will be overseeing all clinical matters as usual during this time.
You can check the new schedule and read about the new practitioners on our website:
http://www.nycacupuncture.com/gldocbios.html
http://www.nycacupuncture.com/patientinfo.html
Lourdes Guzman will continue to offer Reiki treatments on Saturdays.
http://www.nycacupuncture.com/patientinfo.html
Yours in peace,
Naomi Rabinowitz, MD
19 July 2003
Turning Point Acupuncture
1841 Broadway, Suite 509
New York City, NY 10023
212 489-5038
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copyright 2003 Naomi Rabinowitz. All Rights Reserved. This newsletter may be reproduced or transmitted in its entirety only, including this copyright line.
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