7 year old with endocarditis

[Guest guest]

Hi all,

I have a 7 year old coming to see me next week with endocarditis. I

have never seen this patient before. All I know is that he has been

repeatedly treated with antibiotics, the inflammation disappears and

then always comes back. Has anyone had any experience treating this?

Any thoughts would be greatly appreciated.

Thanks in advance,

 

 

Sarah Fink, L.Ac

[Guest guest]

Sarah,

A few things concern me.

 

1) How can you treat someone with such a serious problem unless you

have confidence and experience in Chinese medical cardiology? The

best thing to do would be to refer to someone with experience in this

area. Too many red flags with a child and endocarditis in my

opinion. A point prescription or simple herbal formula may not be

enough in this case.

 

2) There are no simple protocols for such a problem. Cardiology is

presently a specialty in Chinese medicine, there are a few good books

I can recommend for relevant pathomechanisms, including

" Pathmechanisms of the Heart " from Paradigm Press, and " The Treatment

of Cardiovascular Diseases in " by Bob Flaws, etc.

from Blue Poppy Press. If you do decide to treat this patient, look

at these books for comprehensive information. Without a CM diagnosis,

there isn't much else to say at this point.

 

3) To sum up, I see too many posts on this and other lists where it

appears that practitioners don't have the resources or connections to

research new cases or challenging patient issues. It concerns me that

you and other practitioners should even have to ask these questions.

As part of our education, we should be able to access resources, refer

to more experienced practitioners, rather than just ask for points or

herb formulas without even seeing the patient or making a

comprehensive CM diagnosis. Finally, a comprehensive library of

Chinese medical texts, and preferably some knowledge of medical

Chinese, is a must for the variety of patients and problems we are

being asked to treat.

 

 

On May 21, 2008, at 10:01 PM, sfink23 wrote:

 

> Hi all,

> I have a 7 year old coming to see me next week with endocarditis. I

> have never seen this patient before. All I know is that he has been

> repeatedly treated with antibiotics, the inflammation disappears and

> then always comes back. Has anyone had any experience treating this?

> Any thoughts would be greatly appreciated.

> Thanks in advance,

>

> Sarah Fink, L.Ac

>

>

>

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

Wow, a little harsh don't you think? First of all the patient is

currently being treated biomedically (albiet unsuccessfully), and she

hasn't seen the patient yet so it's not possible to form a TCM

diagnosis until she has. The appointment is a week away and the

practitioner is looking for possible resources to point her in the

right direction. As far as I'm concerned there is nothing to be

concerned about at this point.

As far as TCM specialists...I am of the popular opinion that it is a

contradiction of terms. The more specializing we do the more we are

pulling away from treating the patient as a whole mentality that has

made this profession the honorable success that it is. I realize

that the opinion is split, but there is certainly no danger for a

qualified, experienced practitioner to see this girl. I applaud her

efforts in trying to rally all the resources she can about this

condition before the patient ever hits the office.

Just my opinion,

Wishing you wisdom,

Randy

 

Chinese Medicine ,

<zrosenbe wrote:

>

> Sarah,

> A few things concern me.

>

> 1) How can you treat someone with such a serious problem unless

you

> have confidence and experience in Chinese medical cardiology? The

> best thing to do would be to refer to someone with experience in

this

> area. Too many red flags with a child and endocarditis in my

> opinion. A point prescription or simple herbal formula may not be

> enough in this case.

>

> 2) There are no simple protocols for such a problem. Cardiology

is

> presently a specialty in Chinese medicine, there are a few good

books

> I can recommend for relevant pathomechanisms, including

> " Pathmechanisms of the Heart " from Paradigm Press, and " The

Treatment

> of Cardiovascular Diseases in " by Bob Flaws, etc.

> from Blue Poppy Press. If you do decide to treat this patient,

look

> at these books for comprehensive information. Without a CM

diagnosis,

> there isn't much else to say at this point.

>

> 3) To sum up, I see too many posts on this and other lists where

it

> appears that practitioners don't have the resources or connections

to

> research new cases or challenging patient issues. It concerns me

that

> you and other practitioners should even have to ask these

questions.

> As part of our education, we should be able to access resources,

refer

> to more experienced practitioners, rather than just ask for points

or

> herb formulas without even seeing the patient or making a

> comprehensive CM diagnosis. Finally, a comprehensive library of

> Chinese medical texts, and preferably some knowledge of medical

> Chinese, is a must for the variety of patients and problems we

are

> being asked to treat.

>

>

> On May 21, 2008, at 10:01 PM, sfink23 wrote:

>

> > Hi all,

> > I have a 7 year old coming to see me next week with endocarditis.

I

> > have never seen this patient before. All I know is that he has

been

> > repeatedly treated with antibiotics, the inflammation disappears

and

> > then always comes back. Has anyone had any experience treating

this?

> > Any thoughts would be greatly appreciated.

> > Thanks in advance,

> >

> > Sarah Fink, L.Ac

> >

> >

> >

>

>

> Chair, Department of Herbal Medicine

> Pacific College of Oriental Medicine

> San Diego, Ca. 92122

 

[Guest guest]

Randy,

I don't think it is too harsh. This is a potentially life

threatening condition, and in China a child like this would

automatically be referred to someone with long-term experience, a lao

zhongyi. If I were a young practitioner, I'd be very careful and

cautious about treating someone with such a condition. Granted, in

the West, we don't have so many lao zhongyi, so we need to learn what

we can. I am just surprised that the general education doesn't

prepare graduates for such difficult cases, or teach how to access

specific resources that would be helpful. Many types of conditions

are referred to the TCM group, but I do see a lack of differential CM

diagnosis and an over dependence on point protocols in responses to

inquiries.

 

A " specialist " in CM means in-depth study of specific patterns and

conditions, and the experience of a practitioner who has treated many

cases. How can we move forward without access to the experience of

those practitioners who have preceded us and specialized in difficult

cases? If a patient has been referred with a serious biomedical

condition such as endocarditis, it is the obligation of the

practitioner to be familiar with the biomedical parameters of the

condition, and then to look at the Chinese medical literature to

reframe the condition into differentiated zang-fu patterns.

 

 

 

 

On May 25, 2008, at 11:26 AM, rparrny wrote:

 

> Wow, a little harsh don't you think? First of all the patient is

> currently being treated biomedically (albiet unsuccessfully), and she

> hasn't seen the patient yet so it's not possible to form a TCM

> diagnosis until she has. The appointment is a week away and the

> practitioner is looking for possible resources to point her in the

> right direction. As far as I'm concerned there is nothing to be

> concerned about at this point.

> As far as TCM specialists...I am of the popular opinion that it is a

> contradiction of terms. The more specializing we do the more we are

> pulling away from treating the patient as a whole mentality that has

> made this profession the honorable success that it is. I realize

> that the opinion is split, but there is certainly no danger for a

> qualified, experienced practitioner to see this girl. I applaud her

> efforts in trying to rally all the resources she can about this

> condition before the patient ever hits the office.

> Just my opinion,

> Wishing you wisdom,

> Randy

>

> Chinese Medicine ,

> <zrosenbe wrote:

> >

> > Sarah,

> > A few things concern me.

> >

> > 1) How can you treat someone with such a serious problem unless

> you

> > have confidence and experience in Chinese medical cardiology? The

> > best thing to do would be to refer to someone with experience in

> this

> > area. Too many red flags with a child and endocarditis in my

> > opinion. A point prescription or simple herbal formula may not be

> > enough in this case.

> >

> > 2) There are no simple protocols for such a problem. Cardiology

> is

> > presently a specialty in Chinese medicine, there are a few good

> books

> > I can recommend for relevant pathomechanisms, including

> > " Pathmechanisms of the Heart " from Paradigm Press, and " The

> Treatment

> > of Cardiovascular Diseases in " by Bob Flaws, etc.

> > from Blue Poppy Press. If you do decide to treat this patient,

> look

> > at these books for comprehensive information. Without a CM

> diagnosis,

> > there isn't much else to say at this point.

> >

> > 3) To sum up, I see too many posts on this and other lists where

> it

> > appears that practitioners don't have the resources or connections

> to

> > research new cases or challenging patient issues. It concerns me

> that

> > you and other practitioners should even have to ask these

> questions.

> > As part of our education, we should be able to access resources,

> refer

> > to more experienced practitioners, rather than just ask for points

> or

> > herb formulas without even seeing the patient or making a

> > comprehensive CM diagnosis. Finally, a comprehensive library of

> > Chinese medical texts, and preferably some knowledge of medical

> > Chinese, is a must for the variety of patients and problems we

> are

> > being asked to treat.

> >

> >

> > On May 21, 2008, at 10:01 PM, sfink23 wrote:

> >

> > > Hi all,

> > > I have a 7 year old coming to see me next week with endocarditis.

> I

> > > have never seen this patient before. All I know is that he has

> been

> > > repeatedly treated with antibiotics, the inflammation disappears

> and

> > > then always comes back. Has anyone had any experience treating

> this?

> > > Any thoughts would be greatly appreciated.

> > > Thanks in advance,

> > >

> > > Sarah Fink, L.Ac

> > >

> > >

> > >

> >

> >

> > Chair, Department of Herbal Medicine

> > Pacific College of Oriental Medicine

> > San Diego, Ca. 92122

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Z'ev,

 

No, I don't think you're harsh either based on the presentation of the question.

 

From the Merck Manual of Diagnosis and Therapy on endocarditis, prognosis

portion: " Untreated, infective endocarditis is always fatal. " It goes on to

discuss that recovery without major complications is less than 10%. Is anyone

scared yet? I would be extraordinarily wary. So without decades of experience,

I'd be referring this 7 year old patient with lightning speed to one of my

clinical professors of merit. And I would present this sort of information to

the parents of this child.

 

I see people on this list discuss Western medical disease states as if they will

be directly applying a treatment protocol that makes sense from Chinese

medicine. On a concurrent post regarding " thrush " ... why is there no comment

that thrush is a secondary sign to an immunocompromised patient? One does not

treat thrush but rather looks for thrush secondary to a harsh treatment protocol

of antibiotic + steroids, or secondary to HIV infection, leukopenia secondary to

leukemia or some other basis for an immunocompromised state. But no one looked

for that. Made me wonder. In other words I see a lot of WM on this list

without differential diagnosis and not a lot of CM diagnostics with CM treatment

protocols. My impression is that this list would be about the latter.

 

If people are going to address Western medical diagnostics, at least read the

etiologies and prognosis sections of the WM literature. The Merck Manual is not

expensive: http://www.merckbooks.com/mmanual/index.html. And you can always do

an online search at http://www.merck.com/mmpe/index.html. I like the hard copy

in my hands so I can open to multiple pages and look back and forth.

 

Then you can ask questions that any medical student learns to ask based on

knowledge. There was no indication in the original question that literature had

been read. I, too, was in shock and awe. Usually a reading of the literature

makes specific questions come up. Normally questions go like: is this

infectious or non-infectious. Was it originally subacute or acute? It's

usually an anaerobic strep infection, but has WM ruled out staph? If it's

subacute now, was it acute upon initial diagnosis and treatment? If so, it

might more likely be staph or pneumococci.

 

Considering the seriousness of the WM diagnosis/prognosis, I'm with you Z'ev. I

think even with your experience, you'd be passing this patient on ... or at

least be attempting to coordinate with the cardiologist who is currently

treating. See if the MD is willing to coordinate CM support during treatment.

But I doubt you would even go this route. I'm thinking you would refer out if

there was someone of merit close at hand.

 

Respectfully,

Emmanuel Segmen

 

 

 

 

[Guest guest]

Dear Dr. Rosenberg,

 

I would like to express my appreciation for your rally-cry for us to raise

the bar, enhance our skill level, and take seriously our responsibility to

patients in such life-threatening situations. While you brought up some

very important general points, in this specific case I cannot help but to

point out that Sarah Fink is an EXCEPTIONAL young practitioner (yet a very

humble one). Sarah was a schoolmate of mine. She apprenticed extensively

with some " lao zhong yi " and sets the bar very high for herself. She

studied in china and is aware of how deep and " specialized " chinese medicine

can be. Most of all, she 'gets' differential diagnosis, and is not the type

of lazy practitioner looking for simplistic one-size-fits-all protocols.

While she is not a " pediatric cardiology " specialist, I have seen her rise

to the ocassion with difficult life-threatening patient cases, pouring her

heart and soul into researching and studying each difficult condition, to

offer the best possible care for each patient. And she is never too proud to

refer patients out to other practitioners with more specialized skills. I

have no doubt she will proceed cautiously and meticulously with such a

tricky case.

 

So while your points were well-taken and many of us needed to hear them,

Randy's message about not being too harsh in this specific case is also a

wise one. Given that the patient is under conventional care, and has come to

Sarah for TCM alternatives, and given Sarah's exceptional meticulousness as

a practitioner, I feel there is nothing wrong with her accepting the

appointment, researching cautiously for a week, then meeting the patient

before deciding if she's comfortable managing his care.

 

Knowing Sarah, I guarantee she's doing an intense crash course on biomedical

and TCM diff. dx and tx of endocarditis as we speak. She's probably reading

all the books you recommended and studying the diff. dx pattern by pattern.

I have every confidence that this young patient will received great care

either directly from Sarah, or a carefully chosen referral to a more

experienced practitioner.

 

As you said, in the west we don't have tons of " lao zhong yi " specialists to

refer to for every tough case, so we must do what we can. And Sarah is doing

everything she can to prepare for this difficult case, including seeking

help from this list. With all due respect, I must say I wish you could have

offered her your valuable recommendations without the stereotype that she's

your average poorly-trained young practitioner looking for one-size-fit-all

protocol... Sarah couldn't be further from that stereotype.

 

 

respectfully,

edith

 

 

On Sun, May 25, 2008 at 11:21 PM, <zrosenbe

wrote:

 

> Randy,

> I don't think it is too harsh. This is a potentially life

> threatening condition, and in China a child like this would

> automatically be referred to someone with long-term experience, a lao

> zhongyi. If I were a young practitioner, I'd be very careful and

> cautious about treating someone with such a condition. Granted, in

> the West, we don't have so many lao zhongyi, so we need to learn what

> we can. I am just surprised that the general education doesn't

> prepare graduates for such difficult cases, or teach how to access

> specific resources that would be helpful. Many types of conditions

> are referred to the TCM group, but I do see a lack of differential CM

> diagnosis and an over dependence on point protocols in responses to

> inquiries.

>

> A " specialist " in CM means in-depth study of specific patterns and

> conditions, and the experience of a practitioner who has treated many

> cases. How can we move forward without access to the experience of

> those practitioners who have preceded us and specialized in difficult

> cases? If a patient has been referred with a serious biomedical

> condition such as endocarditis, it is the obligation of the

> practitioner to be familiar with the biomedical parameters of the

> condition, and then to look at the Chinese medical literature to

> reframe the condition into differentiated zang-fu patterns.

>

>

>

> On May 25, 2008, at 11:26 AM, rparrny wrote:

>

> > Wow, a little harsh don't you think? First of all the patient is

> > currently being treated biomedically (albiet unsuccessfully), and she

> > hasn't seen the patient yet so it's not possible to form a TCM

> > diagnosis until she has. The appointment is a week away and the

> > practitioner is looking for possible resources to point her in the

> > right direction. As far as I'm concerned there is nothing to be

> > concerned about at this point.

> > As far as TCM specialists...I am of the popular opinion that it is a

> > contradiction of terms. The more specializing we do the more we are

> > pulling away from treating the patient as a whole mentality that has

> > made this profession the honorable success that it is. I realize

> > that the opinion is split, but there is certainly no danger for a

> > qualified, experienced practitioner to see this girl. I applaud her

> > efforts in trying to rally all the resources she can about this

> > condition before the patient ever hits the office.

> > Just my opinion,

> > Wishing you wisdom,

> > Randy

> >

> > --- In

Chinese Medicine <Chinese Medicine%40yaho\

ogroups.com>,

>

> > <zrosenbe wrote:

> > >

> > > Sarah,

> > > A few things concern me.

> > >

> > > 1) How can you treat someone with such a serious problem unless

> > you

> > > have confidence and experience in Chinese medical cardiology? The

> > > best thing to do would be to refer to someone with experience in

> > this

> > > area. Too many red flags with a child and endocarditis in my

> > > opinion. A point prescription or simple herbal formula may not be

> > > enough in this case.

> > >

> > > 2) There are no simple protocols for such a problem. Cardiology

> > is

> > > presently a specialty in Chinese medicine, there are a few good

> > books

> > > I can recommend for relevant pathomechanisms, including

> > > " Pathmechanisms of the Heart " from Paradigm Press, and " The

> > Treatment

> > > of Cardiovascular Diseases in " by Bob Flaws, etc.

> > > from Blue Poppy Press. If you do decide to treat this patient,

> > look

> > > at these books for comprehensive information. Without a CM

> > diagnosis,

> > > there isn't much else to say at this point.

> > >

> > > 3) To sum up, I see too many posts on this and other lists where

> > it

> > > appears that practitioners don't have the resources or connections

> > to

> > > research new cases or challenging patient issues. It concerns me

> > that

> > > you and other practitioners should even have to ask these

> > questions.

> > > As part of our education, we should be able to access resources,

> > refer

> > > to more experienced practitioners, rather than just ask for points

> > or

> > > herb formulas without even seeing the patient or making a

> > > comprehensive CM diagnosis. Finally, a comprehensive library of

> > > Chinese medical texts, and preferably some knowledge of medical

> > > Chinese, is a must for the variety of patients and problems we

> > are

> > > being asked to treat.

> > >

> > >

> > > On May 21, 2008, at 10:01 PM, sfink23 wrote:

> > >

> > > > Hi all,

> > > > I have a 7 year old coming to see me next week with endocarditis.

> > I

> > > > have never seen this patient before. All I know is that he has

> > been

> > > > repeatedly treated with antibiotics, the inflammation disappears

> > and

> > > > then always comes back. Has anyone had any experience treating

> > this?

> > > > Any thoughts would be greatly appreciated.

> > > > Thanks in advance,

> > > >

> > > > Sarah Fink, L.Ac

> > > >

> > > >

> > > >

> > >

> > >

> > > Chair, Department of Herbal Medicine

> > > Pacific College of Oriental Medicine

> > > San Diego, Ca. 92122

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

I guess you are doing the right thing to look for more resources to

tackle a difficult case. The only thing that matters is to protect

yourslef as a practitioner from treating potentially dangerous

patient. What you can do is to study briefly what western medicine

understands about endocarditis. Ask the patient for all lab. test

results. If it is of an acute case with organic problem, and there

are life-threatening signs, stay away. If it not acute and no

immediate lethal signs, treat it according to pattern

differentiation. The bottom line is if your treatment can make some

differences, you are helping the patient. Make sure you told them

what can you help.

Endocarditis is a viral infected disease. Children will lose their

lives quickly without proper treatment. We have to know our

limitations as well as what we are good at. In this case, if there

is organic malfuction (most likely),cardio muscles defect or defect

of the heart, cure is unlikely except surgery but we can susbtain a

stable condition with herbs. It is a great help already to a 7 yr

old repeatedly infected family. I am sure tcm helps.

 

Regards,

 

SUNG Yuk-ming

[Guest guest]

Chinese Medicine ,

<zrosenbe wrote:

>

>If a patient has been referred with a serious biomedical

condition such as endocarditis, it is the obligation of the

practitioner to be familiar with the biomedical parameters of the

condition, and then to look at the Chinese medical literature to

reframe the condition into differentiated zang-fu patterns.>

 

All of which is in the realm of an experienced, qualified

practitioner. Is it not?

 

Wishing you wisdom,

Randy

[Guest guest]

Emmanuel,

 

I expressed my opinion as a Cardio-Thoracic Intensivist with 16

years experience. From my WM perspective, I would have no problem

with an experienced OM practitioner that was not specialized taking

a look at this girl. Dangerous as this condition can be, she IS

being followed biomedically...and is stable enough to be an

outpatient.

An experienced practitioner should be able to evaluate this patient.

Wishing you wisdom,

Randy

 

Chinese Medicine , " Emmanuel

Segmen " <mrsegmen wrote:

>

> Z'ev,

>

> No, I don't think you're harsh either based on the presentation of

the question.

>

> From the Merck Manual of Diagnosis and Therapy on endocarditis,

prognosis portion: " Untreated, infective endocarditis is always

fatal. " It goes on to discuss that recovery without major

complications is less than 10%. Is anyone scared yet? I would be

extraordinarily wary. So without decades of experience, I'd be

referring this 7 year old patient with lightning speed to one of my

clinical professors of merit. And I would present this sort of

information to the parents of this child.

>

> I see people on this list discuss Western medical disease states

as if they will be directly applying a treatment protocol that makes

sense from Chinese medicine. On a concurrent post

regarding " thrush " ... why is there no comment that thrush is a

secondary sign to an immunocompromised patient? One does not treat

thrush but rather looks for thrush secondary to a harsh treatment

protocol of antibiotic + steroids, or secondary to HIV infection,

leukopenia secondary to leukemia or some other basis for an

immunocompromised state. But no one looked for that. Made me

wonder. In other words I see a lot of WM on this list without

differential diagnosis and not a lot of CM diagnostics with CM

treatment protocols. My impression is that this list would be about

the latter.

>

> If people are going to address Western medical diagnostics, at

least read the etiologies and prognosis sections of the WM

literature. The Merck Manual is not expensive:

http://www.merckbooks.com/mmanual/index.html. And you can always do

an online search at http://www.merck.com/mmpe/index.html. I like

the hard copy in my hands so I can open to multiple pages and look

back and forth.

>

> Then you can ask questions that any medical student learns to ask

based on knowledge. There was no indication in the original

question that literature had been read. I, too, was in shock and

awe. Usually a reading of the literature makes specific questions

come up. Normally questions go like: is this infectious or non-

infectious. Was it originally subacute or acute? It's usually an

anaerobic strep infection, but has WM ruled out staph? If it's

subacute now, was it acute upon initial diagnosis and treatment? If

so, it might more likely be staph or pneumococci.

>

> Considering the seriousness of the WM diagnosis/prognosis, I'm

with you Z'ev. I think even with your experience, you'd be passing

this patient on ... or at least be attempting to coordinate with the

cardiologist who is currently treating. See if the MD is willing to

coordinate CM support during treatment. But I doubt you would even

go this route. I'm thinking you would refer out if there was

someone of merit close at hand.

>

> Respectfully,

> Emmanuel Segmen

>

>

>

>

[Guest guest]

Z've,

 

I'm not sure this child would be automatically referred to a

specialist in China or anywhere else, because no one here knows

exactly what we are dealing with.

We have an appointment made (probably by a parent) stating that the

child was given this diagnosis. The child must be rock solid stable

and without symptoms cause I don't know of any pediatrician that

would discharge from the hospital a 7 year old child with active

endocarditis.

It's possible the infection, either bacterial or viral was

successfully treated and returned and was treated again and the child

is now symptom free and the parent is looking to keep the child from

getting any more recurrent infections. It's possible that this child

never had endocarditis and the parent is just mistaken.

The point here is that nothing is known until the child comes in and

a thorough history and physical is taken along with a review of the

biomedical diagnosis and any lab tests and transesophageal or

transthoracic echo reports ect. Was it considered bacterial or

viral? Were vegatations noted on the echo? Did they persist after

treatment? Were there any positive blood cultures? Are they negative

now?

The best person to take that information would be an experienced

generalist not a specialist...and to ship such a patient off to a

specialist without knowing the facts is at best irresponsible and

could end up being downright embarrassing.

The best practitioners, experienced or not know thier limitations and

recognize when they need to get someone else involved that has more

specific experience on a certain condition.

And although I've seen it stated on several posts (other posts, not

yours) I will disagree with the following: Protecting yourself

against lawsuits is NOT the most important thing, protecting the

patient is and THAT should be your first priority.

From what very little information that has been given the

practitioner thus far, this child appears to be in no immediate

danger, and I will stand by my opinion that she be applauded for her

efforts to find out everything she can before the child's

appointment.

A practitioner that cares so much to put in the time to research

before an appointment, will care enough to refer a patient to a more

experienced practitioner if this condition is beyond her scope of

knowledge.

Wishing you wisdom,

Randy

 

Chinese Medicine ,

<zrosenbe wrote:

>

> Randy,

> I don't think it is too harsh. This is a potentially life

> threatening condition, and in China a child like this would

> automatically be referred to someone with long-term experience, a

lao

> zhongyi. If I were a young practitioner, I'd be very careful and

> cautious about treating someone with such a condition. Granted,

in

> the West, we don't have so many lao zhongyi, so we need to learn

what

> we can. I am just surprised that the general education doesn't

> prepare graduates for such difficult cases, or teach how to access

> specific resources that would be helpful. Many types of

conditions

> are referred to the TCM group, but I do see a lack of differential

CM

> diagnosis and an over dependence on point protocols in responses

to

> inquiries.

>

> A " specialist " in CM means in-depth study of specific patterns

and

> conditions, and the experience of a practitioner who has treated

many

> cases. How can we move forward without access to the experience

of

> those practitioners who have preceded us and specialized in

difficult

> cases? If a patient has been referred with a serious biomedical

> condition such as endocarditis, it is the obligation of the

> practitioner to be familiar with the biomedical parameters of the

> condition, and then to look at the Chinese medical literature to

> reframe the condition into differentiated zang-fu patterns.

>

>

>

[Guest guest]

Dear Doug and friends:

 

Oh, dear. I am sorry to have created another tension by bringing up

my reticence to post on CHA. I appreciate your post, Doug, and I

deeply appreciate all the work that must go into moderating such a

lively group of practitioners and scholars. Kudos to you for your

fine efforts.

 

I do agree that many of us can work harder to find that balance

between opinion, advice, and judgment. (As a mother of three, I find

myself dancing that line all the time!) It's nice to remind each

other that we are all here for the ultimate goal of restoring health

and, most importantly, doing no harm in the process.

 

all the best,

Julia Carpenter

 

Chinese Medicine , " Douglas

" wrote:

>

> Having dragged the good name of CHA in to this (?!) and as the

> moderator of that forum, I'll respond that CHA does have a policy of

> not criticizing people for not knowing enough before they post. I

> apologize and recognize that is often not the case.

> As to this case, no one has responded to the only question Sarah

> originally asked. " Has anyone had any experience treating this? "

>

> If there is an opinion as to this is too difficult for the responder

> to tackle then that is an opinion.It may be a very good opinion. But

> patients come to us for a number of reasons and Sarah has a patient

> coming to see her. If she had the opinion from someone who has

> actually treated this, " it's easy " or " it's dangerous " then she can

> has a basis to act appropriately. I believe we, even the

> non-specialist acupuncturist can make halp people (even if there is no

> treatment) than the alternatives patients might turn to.

>

> I would rather that practitioners post here (or on CHA) than be

> pre-censored from others opinions. The fact that she has reached out

> is the best sign of her judgment in this case. And I believe that is

> the point of having an open discussion. It would be truly be dangerous

> for practitioners not to seek advice from those who have experience on

> these forums.

>

>

>

>

>

[Guest guest]

Hi all

I appreciate all your insights.

I just wanted to clarify a few things about the situation.

I have never talked to this patient before, he scheduled through the office

manager.

Another health care practitioner had told me they had referred an asymptomatic 7

year old boy with endocarditis to me, and I wasn’t sure if this particular

patient that scheduled was that same boy. In this case it was inappropriate to

refer him out before ever seeing him.

In case it was the endocarditis patient, I have the contact information of a

more experienced herbalist in the area to give to the boy’s mother at the

initial consultation.

In the meantime, I wanted to gather as much information as possible about TCM

practitioners’ experience treating this extremely serious condition. I

consulted various sources, Western and TCM books, mentors, and colleagues, in

addition to making a post on this list serve. I saw this as an opportunity to

understand treatment of the heart and pericardium more deeply,

even if I wasn't the treating practitioner. I was not looking for a simple

point prescription or herbal formula.

The real problem, I believe, is that my post was too general. I apologize for

any misunderstanding, although it seems like an important conversation to have,

and will be more specific if I post something in the future.

 

Sarah

 

 

 

 

 

[Guest guest]

Doug,

Thank you for your reply and observations of

the initial question and the convoluted path it

has taken.

 

I was going to point out that the original post

did not ask for anything other than others experiences,

no points, no herbs, just what to be prepared for.

 

I am a new practitioner (new, not young).

I've wanted to post here asking for guidance from

experienced people, actually tried once or twice,

but the only replies I received were those that

I was using too many western terms.

 

sigh.....

 

I have a couple of stubborn cases that I'd like to

discuss, but I am literally afraid that my questions

will be critiqued for proper language and not content.

 

I'm in a very steep learning curve and at times it's

a slippery slope.

 

it would be nice to feel safe to ask to hear/share

the knowledge of the " masters " who have once been on this

slope themselves.....

 

jean

 

> Having dragged the good name of CHA in to this (?!) and as the

> moderator of that forum, I'll respond that CHA does have a policy of

> not criticizing people for not knowing enough before they post. I

> apologize and recognize that is often not the case.

> As to this case, no one has responded to the only question Sarah

> originally asked. " Has anyone had any experience treating this? "

>

> If there is an opinion as to this is too difficult for the responder

> to tackle then that is an opinion.It may be a very good opinion. But

> patients come to us for a number of reasons and Sarah has a patient

> coming to see her. If she had the opinion from someone who has

> actually treated this, " it's easy " or " it's dangerous " then she can

> has a basis to act appropriately. I believe we, even the

> non-specialist acupuncturist can make halp people (even if there is

no

> treatment) than the alternatives patients might turn to.

>

> I would rather that practitioners post here (or on CHA) than be

> pre-censored from others opinions. The fact that she has reached out

> is the best sign of her judgment in this case. And I believe that is

> the point of having an open discussion. It would be truly be

dangerous

> for practitioners not to seek advice from those who have experience

on

> these forums.

>

>

[Guest guest]

Hi Jean!

I am going to jump in again with inappropriate responses! ...probably too

soon, but the issues you raise are vital.

 

You wrote:

---

I've wanted to post here asking for guidance from

experienced people, actually tried once or twice,

but the only replies I received were those that

I was using too many western terms.

---

 

As you begin to practice more and more, you will begin to realise how useful CM

terms are, and how confusing WM terms usually are. There are very important

issues here. I hope you don't despair - this process is necessary for anyone who

wants to " get " CM. It is a different way of thinking and being. It is the

difference between holistic and reductionistic, human-centred and

machine-centred.

 

You wrote:

---

no points, no herbs, just what to be prepared for.

---

 

As far as I can see you got what you were asking for, from several different

angles. You should now feel very prepared to deal with the most vital aspect of

this case - being absolutely sure to take care of yourself in case the child

takes a nasty turn for the worse.

One of my teachers (a lao zhongyi) actually will not treat children because they

are so changeable + how easy it is to sue natural medicine practitioners in

north america since they don't really know what's going on...I mean practising

medicine without a license and so forth. I do admit he is timid, but he has a

point.

 

You wrote:

---

I have a couple of stubborn cases that I'd like to

discuss, but I am literally afraid that my questions

will be critiqued for proper language and not content.

---

 

Language at this point, Jean, is absolutely the content. One of my greatest

clinical hurdles lies in how to " deprogram " people of the language they use to

keep themselves sick - " but I have ABC (practically unpronounceable (and

therefore unknowable) latin name), how can I change that? My [obscure

organ/gland] is producing the wrong chemicals!! " How do we get past that?? How

do we justify this introjection by medical practitioners to patients that they

have ERYTHEMA MULTIFORMIS ( " variously shaped red patches on the skin " ), a

DISEASE WITH NO KNOWN CURE, and it is NOT EVEN KNOWN WHAT CAUSES IT, but perhaps

it is MEDIATED THROUGH A PATHOLOGICALLY SELF-DESTRUCTIVE AUTOIMMUNE RESPONSE.

 

There should be courses taught on this. I have thought about developing one.

 

Hugo

 

 

 

________

Sent from Mail.

A Smarter Email http://uk.docs./nowyoucan.html

 

 

[Guest guest]

Jean,

 

As an OM student I cant offer any experiences from the OM side of

things, however as a Cardio-Thoracic Intensivist with 16 years

experience I can offer my experience on the biomedical aspects of the

case you may be dealing with.

 

Assuming that is child does have endocarditis (and we don't know

anything for sure until you see the patient and do a thorough H & P)it

would benefit you to know the severity of the condition from a

biomedical standpoint. Ask for recent copies of labs, echos, and any

nuclear imaging studies that have been done. Doesn't sound like this

child needed surgery, but ask for both pre and post operative reports

if applicable.

A list of all antibiotics both past and present will help. Certain

antibiotics such as Gentamycin can be both nephrotoxic and ototoxic

(Vancomycin has ototoxic issues as well) and you (or whomever treats

this child) may need to treat the sequelea of antibiotic therapy.

If this child has now or has ever had vegetations on the valves any

sort of needling may be an issue. From a biomedical perspective I

have seen reports of acupunture causing endocarditis. From the

average depths of the needles it makes no sense to me that such a

thing could happen (unless a needle hit an artery or vien)but it

needs to be considered. Bodywork may be a better option to open

channels.

If this child did have surgery and has a new valve, coumadin is often

given for the first 3 months (for adults anyway, I don't do kids)

even if it is a tissue valve, mechanical valves are given lifetime

coumadin (not likely to give a kid a mechanical valve). Levels in

adults are maintained at an INR of 2.5 to 3.5 so any needling or

heavy manipulation again could cause problems with bleeding. And

because it is SO common for coumadin levels to get out of whack I

would suggest ANY patient taking coumadin for ANY reason to have a

recent level done before having acupuncture.

My guess is this child is very stable because no pediatrician would

discharge from the hospital unless rock solid stable.

If you need help sorting through biomedical test results, I'd be

happy to help.

Hope this helps,

Wishing you wisdom,

Randy

 

Chinese Medicine , " Jean "

<greypal wrote:

>

> Doug,

> Thank you for your reply and observations of

> the initial question and the convoluted path it

> has taken.

>

> I was going to point out that the original post

> did not ask for anything other than others experiences,

> no points, no herbs, just what to be prepared for.

>

> I am a new practitioner (new, not young).

> I've wanted to post here asking for guidance from

> experienced people, actually tried once or twice,

> but the only replies I received were those that

> I was using too many western terms.

>

> sigh.....

>

> I have a couple of stubborn cases that I'd like to

> discuss, but I am literally afraid that my questions

> will be critiqued for proper language and not content.

>

> I'm in a very steep learning curve and at times it's

> a slippery slope.

>

> it would be nice to feel safe to ask to hear/share

> the knowledge of the " masters " who have once been on this

> slope themselves.....

>

>

[Guest guest]

Hi Hugo, Jean and Sarah,

 

I have to say, Hugo, you expressed more eloquently than me much of what I wanted

to say on this topic.

 

Jean and Sarah, the death or permanent disability of your patient is so much

more harsh than anything you or I can " say " to each other. No? I've had

patients die in my care, and I can feel every one of their transitions

irrelevent of whether an objective observe could or could not positively

critique my actions. I'm personally honored when someone like Dr. Ping Qi Kang,

whom I've worked with, slaps my comments aside and gets my attention with a

strong comment or strong advice. I'm honored that he thinks I'm able to hear

his (occasionally harsh) words or that he feels I can attune to the subtley of

what's important in what he's got to say. That's a huge complement to me. I'm

glad, too, that he can shatter my illusions when he sees fit. It does take some

strength to connect with a senior teacher for the purpose of getting shattered.

(^;

 

By now, Sarah, you many have seen this 7 year old patient. You must realize

that this person faces a more than 50% chance of multiple open heart surgeries

before adulthood ... if they're lucky enough to get to adulthood. You asked for

comment and experience. My experiences have been wincing at any child having to

get valves installed in their growing hearts. Hopefully you have read the riot

act to the parents and redirected them to a senior colleague who can work

directly with the cardiologist in charge of the case.

 

If any of this sounds harsh, I offer you my deepest condolences. Really.

 

Respectfully,

Emmanuel Segmen

 

 

[Guest guest]

julia: you are right. the reality is, not all of us live in big

cities where there are lots of acupuncturists to talk to. i think that

no matter how much research we do on our own, the advice of people who

have experience with a particular type of case is invaluable.

 

with regards to the endocarditis case, it appears that the patient is

ALREADY under the care of a specialist, who has repeatedly tried to

treat the problem without sucess. it's so great that patients have a

choice to use complementary medicine to help them when other methods

have failed.

 

marie

[Guest guest]

Dear Dr. Chan,

I accept your clarification of this situation by your heart-felt

recommendation of Sarah. One must remember that on an e-mail group

where the other party is not known, it is impossible to tell who is on

the other side of the internet connection. I once had a conversation

on this group with someone who wasn't even trained in Chinese

medicine, but only admitted it after several rebuttals from people in

this group. All I saw was, as Sarah points out elsewhere, a very

simple and shocking inquiry without enough information to judge

whether this was a responsible action or not. Now that the situation

is clear, I withdraw my original concerns and objections.

E-mail is not always the best medium for expressing our concerns.

Quite frankly, I was most concerned for Sarah that she was potentially

facing a 'red flag' situation, as Emmanuel so eloquently pointed out.

 

 

 

On May 26, 2008, at 2:29 AM, Edith Chan, L.Ac. wrote:

 

> Dear Dr. Rosenberg,

>

> I would like to express my appreciation for your rally-cry for us to

> raise

> the bar, enhance our skill level, and take seriously our

> responsibility to

> patients in such life-threatening situations. While you brought up

> some

> very important general points, in this specific case I cannot help

> but to

> point out that Sarah Fink is an EXCEPTIONAL young practitioner (yet

> a very

> humble one). Sarah was a schoolmate of mine. She apprenticed

> extensively

> with some " lao zhong yi " and sets the bar very high for herself. She

> studied in china and is aware of how deep and " specialized " chinese

> medicine

> can be. Most of all, she 'gets' differential diagnosis, and is not

> the type

> of lazy practitioner looking for simplistic one-size-fits-all

> protocols.

> While she is not a " pediatric cardiology " specialist, I have seen

> her rise

> to the ocassion with difficult life-threatening patient cases,

> pouring her

> heart and soul into researching and studying each difficult

> condition, to

> offer the best possible care for each patient. And she is never too

> proud to

> refer patients out to other practitioners with more specialized

> skills. I

> have no doubt she will proceed cautiously and meticulously with such a

> tricky case.

>

> So while your points were well-taken and many of us needed to hear

> them,

> Randy's message about not being too harsh in this specific case is

> also a

> wise one. Given that the patient is under conventional care, and has

> come to

> Sarah for TCM alternatives, and given Sarah's exceptional

> meticulousness as

> a practitioner, I feel there is nothing wrong with her accepting the

> appointment, researching cautiously for a week, then meeting the

> patient

> before deciding if she's comfortable managing his care.

>

> Knowing Sarah, I guarantee she's doing an intense crash course on

> biomedical

> and TCM diff. dx and tx of endocarditis as we speak. She's probably

> reading

> all the books you recommended and studying the diff. dx pattern by

> pattern.

> I have every confidence that this young patient will received great

> care

> either directly from Sarah, or a carefully chosen referral to a more

> experienced practitioner.

>

> As you said, in the west we don't have tons of " lao zhong yi "

> specialists to

> refer to for every tough case, so we must do what we can. And Sarah

> is doing

> everything she can to prepare for this difficult case, including

> seeking

> help from this list. With all due respect, I must say I wish you

> could have

> offered her your valuable recommendations without the stereotype

> that she's

> your average poorly-trained young practitioner looking for one-size-

> fit-all

> protocol... Sarah couldn't be further from that stereotype.

>

> respectfully,

> edith

>

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

Randy,

By specialist, I mean a practitioner who has specific training in

specialties beyond the basic TCM pattern differentiation. This is

required in order to do justice to such areas as skin diseases,

pediatrics, heart disorders, etc. It doesn't mean that their practice

is limited to one specialty. At PCOM we do have courses that address

these 'specialities' in more depth than the usual OM and herbal

medicine classes, as do many other schools, I assume.

 

And, yes, this is in the realm of an experienced, qualified

practitioner.

 

Many moons ago, Sharon Weizenbaum and myself suggested some

criteria for presentation of cases that would allow useful comments

with enough depth to be useful. Emmanuel has suggested some criteria

for the presentation of biomedical disorders. It would be most useful

so that those of us who wish to offer help have some basis for doing

so with meaningful detail.

 

 

On May 26, 2008, at 3:35 AM, rparrny wrote:

 

> Chinese Medicine ,

> <zrosenbe wrote:

> >

> >If a patient has been referred with a serious biomedical

> condition such as endocarditis, it is the obligation of the

> practitioner to be familiar with the biomedical parameters of the

> condition, and then to look at the Chinese medical literature to

> reframe the condition into differentiated zang-fu patterns.>

>

> All of which is in the realm of an experienced, qualified

> practitioner. Is it not?

>

> Wishing you wisdom,

> Randy

>

>

>

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

Sarah,

I am sorry I reacted so strongly to your posting, it actually

came out a lot more intense than I intended. That is sometimes the

problem I think with e-mail, is that one doesn't realize how it looks

at the other end of the internet.

As you point out, however, I had no way of knowing who you are,

your credentials, or the particulars of handling a young patient with

a life-threatening disease. So I wanted to be sure that this child

was handled responsibly and safely, for your sake and hers.

I am at your service in the future, if you wish for my comments

on cases, time allowing.

 

 

On May 27, 2008, at 11:53 AM, Sarah Fink wrote:

 

> Hi all

> I appreciate all your insights.

> I just wanted to clarify a few things about the situation.

> I have never talked to this patient before, he scheduled through the

> office manager.

> Another health care practitioner had told me they had referred an

> asymptomatic 7 year old boy with endocarditis to me, and I wasn’t

> sure if this particular patient that scheduled was that same boy. In

> this case it was inappropriate to refer him out before ever seeing

> him.

> In case it was the endocarditis patient, I have the contact

> information of a more experienced herbalist in the area to give to

> the boy’s mother at the initial consultation.

> In the meantime, I wanted to gather as much information as possible

> about TCM practitioners’ experience treating this extremely serious

> condition. I consulted various sources, Western and TCM books,

> mentors, and colleagues, in addition to making a post on this list

> serve. I saw this as an opportunity to understand

> treatment of the heart and pericardium more deeply, even if I wasn't

> the treating practitioner. I was not looking for a simple point

> prescription or herbal formula.

> The real problem, I believe, is that my post was too general. I

> apologize for any misunderstanding, although it seems like an

> important conversation to have, and will be more specific if I post

> something in the future.

>

> Sarah

>

>

[Guest guest]

Randy,

You are assuming a lot here, based on the fact that little or no

information was given about the patient or the practitioner. Seeing a

post on such a sensitive topic, we are supposed to assume that 1) the

poster is a licensed acupuncturist, even when students or non-

practitioners post to the TCM group. 2) Given that it was impossible

to tell the credentials and experience of the poster, we are given no

knowledge if the poster is planning to treat the patient or not,

although we can, on past experience assume that is possible 3) Given

that different countries and states have different training and

licensing standards, how do we know if the practitioner should be

seeing a red-flag patient such as this?

 

Douglas has expressed his concern that everyone should feel safe

and welcome in such sites. But this can only happen if professional

standards are adhered to. Doug, as moderator of a professional site

must know that without knowing the identity of a poster, that

recommendations and information can be used to nefarious means. A

" feel-good " attitude may be welcoming, but it can easily be abused. I

do not feel comfortable giving technical/professional advice in

situations where the individual may not have the training or license

to practice Chinese medicine competently. The only way this can be

assured is by each poster giving their credentials and background.

Remember, this is the internet, the great land of fraudulent identities.

 

Dr. Chan has vouched for Sarah's credentials, and I have no

reservations after reading Dr. Chan's post. However, I stand by my

feeling that the TCM group needs to upgrade its standard and request

all posters to give their training and background, and post in

sufficient detail so that cases and recommendations can be handled in

a professional manner. Otherwise, I will continue to feel

uncomfortable giving advice on this and other sites.

 

 

 

On May 26, 2008, at 10:33 AM, rparrny wrote:

 

> From what very little information that has been given the

> practitioner thus far, this child appears to be in no immediate

> danger, and I will stand by my opinion that she be applauded for her

> efforts to find out everything she can before the child's

> appointment.

> A practitioner that cares so much to put in the time to research

> before an appointment, will care enough to refer a patient to a more

> experienced practitioner if this condition is beyond her scope of

> knowledge.

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

Hi Sarah and All,

 

You wrote:

---

The real problem, I believe, is that my post was too general. I

apologize for any misunderstanding, although it seems like an important

conversation to have, and will be more specific if I post something in

the future.

---

 

Thank you for writing this, it's important.

 

Hugo

 

 

________

Sent from Mail.

A Smarter Email http://uk.docs./nowyoucan.html

 

 

[Guest guest]

Hi Randy and All,

 

I have no idea

what you believe and such, Randy, so I will just work with the very

cut-and-dried statement you have provided, which I have reproduced

below:

 

You wrote:

---

I will disagree with the

following: Protecting yourself

against lawsuits is NOT the most

important thing, protecting the

patient is and THAT should be

your first priority.

---

 

The first thing I will say is that

you would probably have an interesting conversation with (one of) my

teacher(s) on this point. He is now an old doctor, originally a

western trained MD (switched over a few years into his western

practice of medicine), head of several hospital departments in his

time and so on and so forth. He has come to the conclusion that one's

self comes first, otherwise misunderstandings occur. This is another

way of saying that boundaries should be clear: He would not, as I

would not, " selflessly " give up his life for a stranger as

an automatic course of action. Since he, and I, have this primal

reflex for the survival of the self, it would be naive to make any

statements that gloss over this instinct, though our motives might be

the best. Therefore, we cannot hold anyone else above us in lesser

situations (where our survival is not threatened) without recognising

the basic instinct which all human beings have (and have /for a

reason/). Even within traditional Chinese morality structures where

the child is supposed to take care of the parents (i.e. parents

" first " , child second), this is supposed to happen via the

child fulfilling all duties and obligations, which incidentally,

involve the child becoming as personally powerful as possible by

taking care of themselves first so that there is so much excess of

wealth that the parents reap the appropriate benefit. Another way of

putting this is that the child has to be willing to give up their

life, but the parent would never permit it, because in actual fact,

the child comes first, as does their training in how to be selfless.

Of course, like anything else, this process can be perverted as

well.

 

The overall principle can be seen at

work in other areas. In lifeguard training the rescuer comes first,

/then/ the person needing rescue. A lifeguard without this

understanding will place everyone's lives in jeopardy. It is a simple

principle, but one that healthcare workers often fumble because the

situation can be so much more subtle than someone drowning...not to

mention seductive. It seems glorious to say, “yes, my patients come

firstâ€. Well mine don't.

 

 

This is about respect. I respect their

position and power. They do not need my paternalism / maternalism.

Like Mr. Woodcock said, “They're /old/, not pathetic!â€

 

The second point continues the

concept of rescuing. One of the missing aspects of western medicine

as commonly practiced is the issue of humanity and heart. The process

of the displacement of the human being in favour of an organic

pathology is so slick these days that it is almost unarguable that it

should be that way. We are essentially talking about infantilising

people, otherwise known as keeping them under control. While it can

be very useful to tell a patient that they don't understand what they

are talking about, we can carry out this action with the intent of

giving an assist in their quest for emancipation, or... simply to get

them out of the way. Our way. This is “rescuingâ€. In other words,

the patient stops doing anything, the Doctor will do it all, because

Doctor knows best - this despite the fact that the patient is in

possession of the most advanced organic laboratory, supercomputer,

nanomachine factory and robot on the planet, not to mention the

buddha-nature itself. What I mean to say here is that Doctors have a

mere bit of knowledge over anyone else, and this requires a great

deal more respect for the patient. To have heart in clinical practice is not

simply to " care " , it is also to respect. Respect the tremendous amount of

information not available to you regarding the patient's life, and the lives of

those he or she loves.

 

 

To sum: putting a patient above one's

own well-being trespasses on one's spouse, children, parents, and of

course, one's own self – as such, it is an indefensible position in

the vast majority of cases.

 

Finally, as a counterpoint to your

statement, I will state that protecting oneself is the most important

thing unless circumstances dictate otherwise, and protecting the

patient to the best of your compassionate professional ability is

second fiddle. The subsumation of one's self into the health of the

patient is bad news - confluence is a subtle and potentially damaging

thing (confluence is defined as the dissolving of ego boundaries and

the apparent joining of two or more egos, not the dissolution of the

ego and subsequent realisation of “onenessâ€).

 

 

As a final aside - perhaps, Randy, you

are not aware of how fragile alternative healthcare practices are.

There is no powerful lobby to protect us, there is no association

with high-priced lawyer teams to defend us, and, at least where I am

there is no process whereby we can be assessed by our regulatory body

first – this means that charges of malpractice and so on go

straight to civil or criminal courts. In other words, these sorts of

problems are clinic busters. We are not protected in the way 99% of

MDs are. Everyone, please protect yourself first. If your own wei qi

is weak, how are you going to be able to help _anybody_? In the

practice of protecting ourselves we will help others more

effectively.

 

I hope that this post can be taken in

the spirit in which it is offered, which is as a general discussion

piece. I also apologise for the serious tone, it is probably beyond my

ability to deliver this particular message with more warmth and

compassion.

 

Thank you for your time, (and I hope to hear more from you, Randy!)

 

 

Hugo

 

 

________

Sent from Mail.

A Smarter Email http://uk.docs./nowyoucan.html

 

 

[Guest guest]

Chinese Medicine ,

<zrosenbe wrote:

>

> Randy,

> You are assuming a lot here, based on the fact that little or

no

> information was given about the patient or the practitioner.

 

That was the only point I was trying to make, that little or nothing

was known until a thorough H & P had been done.

 

 

Seeing a

> post on such a sensitive topic, we are supposed to assume that 1)

the

> poster is a licensed acupuncturist, even when students or non-

> practitioners post to the TCM group. 2) Given that it was

impossible

> to tell the credentials and experience of the poster, we are given

no

> knowledge if the poster is planning to treat the patient or not,

> although we can, on past experience assume that is possible 3)

Given

> that different countries and states have different training and

> licensing standards, how do we know if the practitioner should be

> seeing a red-flag patient such as this?

 

I agree with you that a case like this should never be taken

lightly, but to admit your limitations and seek knowledge well

before the patient hits the office told me a lot about this

practitioner. Again, no one knew exactly WHAT she was dealing

with. I tend to be more frightened of an overconfident resident

than one that openly admits they need to learn more. It was never

my intention to downplay the seriousness of the issue, more like my

obsessiveness of a thorough H & P before jumping to any conclusions.

 

 

>

> Douglas has expressed his concern that everyone should feel

safe

> and welcome in such sites. But this can only happen if

professional

> standards are adhered to. Doug, as moderator of a professional

site

> must know that without knowing the identity of a poster, that

> recommendations and information can be used to nefarious means.

A

> " feel-good " attitude may be welcoming, but it can easily be

abused. I

> do not feel comfortable giving technical/professional advice in

> situations where the individual may not have the training or

license

> to practice Chinese medicine competently. The only way this can

be

> assured is by each poster giving their credentials and

background.

> Remember, this is the internet, the great land of fraudulent

identities.

>

> Dr. Chan has vouched for Sarah's credentials, and I have no

> reservations after reading Dr. Chan's post. However, I stand by

my

> feeling that the TCM group needs to upgrade its standard and

request

> all posters to give their training and background, and post in

> sufficient detail so that cases and recommendations can be handled

in

> a professional manner. Otherwise, I will continue to feel

> uncomfortable giving advice on this and other sites.

>

>

 

Both this site and the Herbal Academy required knowing creditials

before allowing posters so the moderator is aware...I will note that

often the space allowed is limited to put in any additional or

detailed information. Dealing with an internet group can be a

double edged sword. You tend to put in more thought than what can

just spill out of your mouth, but without seeing the person face to

face a written word can take many interpretations. But your point

is an important one, maybe having a seperate area where a members

credentials could be reviewed (under files?) might be a solution.

I personally find this group to be fasinating, informative and very

professional.

 

Wishing you wisdom,

Randy

 

>

> On May 26, 2008, at 10:33 AM, rparrny wrote:

>

> > From what very little information that has been given the

> > practitioner thus far, this child appears to be in no immediate

> > danger, and I will stand by my opinion that she be applauded for

her

> > efforts to find out everything she can before the child's

> > appointment.

> > A practitioner that cares so much to put in the time to research

> > before an appointment, will care enough to refer a patient to a

more

> > experienced practitioner if this condition is beyond her scope of

> > knowledge.

>

>

> Chair, Department of Herbal Medicine

> Pacific College of Oriental Medicine

> San Diego, Ca. 92122

 

[Guest guest]

Hugo,

 

What a brilliant rebuttal, thank you. My statement comes from a

western perspective which, as you so eloquently reminded me, is

worlds away from a TCM frame of mind. If western medicine had taken

this approach we wouldn't be in so much trouble today.

Well done.

Wishing you wisdom,

 

Randy

 

Chinese Medicine , Hugo Ramiro

<subincor wrote:

>

> Hi Randy and All,

>

> I have no idea

> what you believe and such, Randy, so I will just work with the very

> cut-and-dried statement you have provided, which I have reproduced

> below:

>

> You wrote:

> ---

> I will disagree with the

> following: Protecting yourself

> against lawsuits is NOT the most

> important thing, protecting the

> patient is and THAT should be

> your first priority.

> ---

>

> The first thing I will say is that

> you would probably have an interesting conversation with (one of) my

> teacher(s) on this point. He is now an old doctor, originally a

> western trained MD (switched over a few years into his western

> practice of medicine), head of several hospital departments in his

> time and so on and so forth. He has come to the conclusion that

one's

> self comes first, otherwise misunderstandings occur. This is another

> way of saying that boundaries should be clear: He would not, as I

> would not, " selflessly " give up his life for a stranger as

> an automatic course of action. Since he, and I, have this primal

> reflex for the survival of the self, it would be naive to make any

> statements that gloss over this instinct, though our motives might

be

> the best. Therefore, we cannot hold anyone else above us in lesser

> situations (where our survival is not threatened) without

recognising

> the basic instinct which all human beings have (and have /for a

> reason/). Even within traditional Chinese morality structures where

> the child is supposed to take care of the parents (i.e. parents

> " first " , child second), this is supposed to happen via the

> child fulfilling all duties and obligations, which incidentally,

> involve the child becoming as personally powerful as possible by

> taking care of themselves first so that there is so much excess of

> wealth that the parents reap the appropriate benefit. Another way of

> putting this is that the child has to be willing to give up their

> life, but the parent would never permit it, because in actual fact,

> the child comes first, as does their training in how to be selfless.

> Of course, like anything else, this process can be perverted as

> well.

>

> The overall principle can be seen at

> work in other areas. In lifeguard training the rescuer comes first,

> /then/ the person needing rescue. A lifeguard without this

> understanding will place everyone's lives in jeopardy. It is a

simple

> principle, but one that healthcare workers often fumble because the

> situation can be so much more subtle than someone drowning...not to

> mention seductive. It seems glorious to say, “yes, my patients

come

> firstâ€. Well mine don't.

>

>

> This is about respect. I respect their

> position and power. They do not need my paternalism / maternalism.

> Like Mr. Woodcock said, “They're /old/, not pathetic!â€

>

> The second point continues the

> concept of rescuing. One of the missing aspects of western medicine

> as commonly practiced is the issue of humanity and heart. The

process

> of the displacement of the human being in favour of an organic

> pathology is so slick these days that it is almost unarguable that

it

> should be that way. We are essentially talking about infantilising

> people, otherwise known as keeping them under control. While it can

> be very useful to tell a patient that they don't understand what

they

> are talking about, we can carry out this action with the intent of

> giving an assist in their quest for emancipation, or... simply to

get

> them out of the way. Our way. This is “rescuingâ€. In other

words,

> the patient stops doing anything, the Doctor will do it all, because

> Doctor knows best - this despite the fact that the patient is in

> possession of the most advanced organic laboratory, supercomputer,

> nanomachine factory and robot on the planet, not to mention the

> buddha-nature itself. What I mean to say here is that Doctors have a

> mere bit of knowledge over anyone else, and this requires a great

> deal more respect for the patient. To have heart in clinical

practice is not simply to " care " , it is also to respect. Respect the

tremendous amount of information not available to you regarding the

patient's life, and the lives of those he or she loves.

>

>

> To sum: putting a patient above one's

> own well-being trespasses on one's spouse, children, parents, and of

> course, one's own self †" as such, it is an indefensible position

in

> the vast majority of cases.

>

> Finally, as a counterpoint to your

> statement, I will state that protecting oneself is the most

important

> thing unless circumstances dictate otherwise, and protecting the

> patient to the best of your compassionate professional ability is

> second fiddle. The subsumation of one's self into the health of the

> patient is bad news - confluence is a subtle and potentially

damaging

> thing (confluence is defined as the dissolving of ego boundaries and

> the apparent joining of two or more egos, not the dissolution of the

> ego and subsequent realisation of “onenessâ€).

>

>

> As a final aside - perhaps, Randy, you

> are not aware of how fragile alternative healthcare practices are.

> There is no powerful lobby to protect us, there is no association

> with high-priced lawyer teams to defend us, and, at least where I am

> there is no process whereby we can be assessed by our regulatory

body

> first †" this means that charges of malpractice and so on go

> straight to civil or criminal courts. In other words, these sorts of

> problems are clinic busters. We are not protected in the way 99% of

> MDs are. Everyone, please protect yourself first. If your own wei qi

> is weak, how are you going to be able to help _anybody_? In the

> practice of protecting ourselves we will help others more

> effectively.

>

> I hope that this post can be taken in

> the spirit in which it is offered, which is as a general discussion

> piece. I also apologise for the serious tone, it is probably beyond

my

> ability to deliver this particular message with more warmth and

> compassion.

>

> Thank you for your time, (and I hope to hear more from you, Randy!)

>

>

> Hugo

>

>

> ________

> Sent from Mail.

> A Smarter Email http://uk.docs./nowyoucan.html

>

>