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Archive for April, 2014

Infertility and TCM (Part 7): The Doctor as the Acupuncture Patient

By David Kreiner MD

April 27th, 2014 at 11:35 pm

 

credit: stuart miles/freedigitalphotos.net

In case it has not been clear up until now, I have my doubts about the scientific explanations regarding acupuncture.

Perhaps, it is too much to ask a 58 year old Western-trained physician to believe in something he cannot see, feel or measure. However, being a younger member of the baby boomer generation I now have my own set of common physical complaints ranging from arthritic joint pains to urinary changes to sleep issues, and more. Therefore, I thought it would be at least interesting if not helpful to go for an acupuncture exam and treatment.

Of course, I was not a typical acupuncture patient since I am a physician who does not entirely accept acupuncture as an effective alternative form of traditional health care. You might say that I am an open-minded skeptic with some very typical complaints for a man my age.

As instructed, I arrived early at the Acupuncture clinic in my school in order to fill out the questionnaire, a routine in most doctors’ offices including my own.  After completing the extensive questionnaire (which made me feel as if I were writing my memoirs) I was called in and brought to a room with a fairly comfortable-looking stretcher/bed. I gowned and for the next 20 minutes answered the acupuncturist’s questions about my complaints, my dietary and bowel habits, exercise routine and more. There were some unusual questions like what foods do I yearn for, do I have bad breath or odors, do I dream, etc.

Then the examination began. I extended both arms over a pillow to have both radial pulses palpated in three positions from just proximal to the wrist crease to about two inches up going towards the elbow crease. Much focus and time was spent on this. After the acupuncturist completed his study of my pulses, he began a very thorough inspection of my tongue along its entire length and on both sides.  Being quite curious about the acupuncturist’s findings I asked him about what he learned about me from the examination.  

Based on my pulse, I showed evidence of weakness in the liver and heart but it was suggested that my beta blocker that I take may account for this. My tongue showed evidence of dampness, one of the Traditional Chinese Medicine pathogens in the body.  The acupuncturist said that based on my history and examination that I exhibited a Kidney Qi or yang deficiency with dampness and that I also suffered from cold, another pathogen.

The acupuncture prescription was aimed at tonifying Qi and yang as well as tonifying kidney and spleen which can cause the dampness.  He was also going to needle points specifically aimed at removing the dampness.  In addition he was going to needle points to calm my “shen” to aid me in my ability to sleep uninterrupted.  He said tonifying the kidney, in addition to needling some bladder points, may help with the urinary problems.  There are specific acupoints for treating all issues and complaints.  The joint pain in my thumb he would address as well.

 

I was anxious and excited to get started.  After all it isn’t every day that you ask someone to stick needles into your body.  

The first needle was inserted perpendicular to my skin about half way up my left leg.  The needle was so thin that it did not hurt as he tapped it through my skin however when he twisted the needle in deeper it caused a very mild “electric-like” shock. It wasn’t that it was painful but it was not a sensation that I am used to feeling. However, the next point he inserted a needle into in the right leg caused an even bigger shock that made my left leg jump a bit which is where I felt the shock.  A few needles later, at a point in the crook of my left arm upon insertion of the needle I felt a shock immediately in my left leg causing it to jump again.  

As I lay on the stretcher I was thinking, “What kind of magic is this that needles inserted on the right side can affect the left and on an upper limb can impact on a lower limb?”. When a needle inserted at the base of my right thumb caused a shock shooting to the tip of my finger I figured that it was a routine reaction when one moves Qi. I lay in the bed with the lights off for about 20-30 minutes very relaxed but a little disappointed when the acupuncturist returned to interrupt my rest and remove the needles.

I had class that evening and was in a great mood. In fact, one of the students asked why I looked so spiffy. It was not the way I was dressed. The next day, I felt great and was in a very good mood again. I cannot say whether I have no more dampness but the cough which plagued me my whole life was gone and that is even while having an upper respiratory infection.

I can say that today,  as a result of my experience with this acupuncture treatment, I am a little less skeptical that there are pathways of Qi in the body that may be manipulated to improve one’s health and well-being.

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Does this experience make you more or less likely to try acupuncture? Why?

 

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Resolve to Know More About The War of Infertility: Surviving and Thriving

By Tracey Minella

April 25th, 2014 at 12:08 pm

 

credit: Ambro/freedigitalphotos.net


Okay. I lied. It’s just about surviving. The thriving only comes when the baby arrives. If the baby arrives.

And the reality of that “if” makes infertility a war. It’s what throws us into survival mode. We battle infertility. We suffer infertility. And every month when we lose another battle, we bleed. Literally and emotionally and financially. We question if we can recover from yet another blow. And like a wounded soldier trembling alone in a trench at night, we look up at the stars and make our secret bargains with the universe. And we worry if we’ll ever win this war and go back to a normal life. To the life others continue living during our physical or emotional absence. To the life we left on hold.

There are no rainbows and unicorns in infertility. No time for fun or relaxation during a war. For parties or thrills or belly laughter. For “thriving”. Sure, you can sometimes kick back momentarily, but your mind rarely disengages from the war at hand. And there is nothing wrong with that, so don’t feel guilty when you don’t want to participate in something others think is fun. When in doubt, sit it out. Like “friendly-fire”, well-meaning allies can unintentionally cause you great pain. Baby shower invites are grenades thrown by friends.

Let’s first acknowledge that the only people qualified to give advice to infertile people are other infertile people. Not your mom or your best friend. Not even your doctor, beyond the medical part. And certainly not your hairdresser’s second cousin’s babysitter. No one else knows what you’re going through…no matter how much they love you.

credit: Resolve

Even those who suffered their own fertility challenges and emerged triumphant can’t fully understand the pain felt by those still waiting for their day. Yes, they walked a mile…maybe ten… in your stirrups. But the filling of previously empty arms changes you. Becoming a parent changes you, even if you still want more children. Your advice may not be as welcome as before.

So here is my not-as-welcome-as before advice: I can tell you to treat yourself well, not because you will enjoy it so much as because it’s one of the few things about infertility that is in your control. Eat well, sleep enough, and exercise because doing so can improve your chances of conceiving. Occasionally, do your favorite pampering-type things if you have the time and money to help with stress relief and feelings of deprivation. If you’re not feeling the romantic walk on the beach thing, do it anyway. Or do something that feels right to reconnect with your partner if the battle is taking its toll on you as a couple. He or she is the only person who is worth that herculean effort.

Control what you can. Ask for help if you need it. Believe it will happen.

Because winning this war isn’t everything. It’s the only thing.

For more information about how you can resolve to learn more about infertility, please go to:

http://www.resolve.org/infertility101  (Basic understanding of the disease of infertility.)

http://www.resolve.org/national-infertility-awareness-week/about.html (About NIAW)

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Does infertility sometimes feel like your own private war? Do you have any tips to share that have helped you?

 

Photo credit: Ambro http://bit.ly/1ffg5MV

 

 

 

 

 

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“Happy Easter. We’re Infertile”: Kicking off National Infertility Awareness Week with Easter Survival Advice

By Tracey Minella

April 20th, 2014 at 11:56 am

 

credit: stock images/free digital photos.net


Like most holidays with a focus on children, Easter can be hard on the infertile. No baskets to fill or cute outfits with little bonnets to buy. And well-meaning but annoying family nagging you as to why.

National Infertility Awareness Week starts today. Maybe it’s the perfect day. If you haven’t shared your struggle with your family or friends and you’re leaning towards doing so, today could be the day. After all, you’ll be together. And someone is bound to throw the annoying baby question out there. Again.

Take control. At a loss for how to start? Here’s a script that works both as a response if you are put on the spot, or as an opening if you don’t want to wait: “Anyone know what today is? It’s the start of National Infertility Awareness Week. [Pause a second for effect]. And we want you to know we’ve been struggling for some time.”

No script needed after that. Expect some to be shocked, while others will say they suspected something was wrong. Some will ask questions. Remember, just because they ask a question, doesn’t mean you have to answer. Share what you want and if you don’t want to say more, just say “We’d rather not get into details right now, but just wanted you all to know where we’re at and hope you’ll be supportive.” Releasing the burden of “the secret” is empowering. Of course, only you know your family best and on rare occasions, the support you seek doesn’t follow. But in most cases, couples who open up about their infertility don’t regret doing so. 

Regardless of whether you spread awareness today… and in honor of National Infertility Awareness Week… Long Island IVF has a special treat this week for those trying to conceive. A free gourmet dinner and cooking demonstration, featuring fertility-friendly foods! Yes, it is free. Please join us for “Fun in the Fertile Kitchen” this Thursday night, April 24 in Islip.

Who couldn’t use a fun night out being catered to by a professional chef among a crowd that gets exactly what you’re going through? Registration is required, attendance is limited, and we have to give the chef a final headcount soon so don’t delay. You do not have to be a Long Island IVF patient to attend. The event details are available here: http://bit.ly/1pRhSan

Give yourself a treat this Easter. Call or email to register today. binabenisch@gmail.com or (516) 398-5248.

 

 

How do you handle Easter? Will we see you on Thursday night?

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TCM and Infertility Part 6: TCM Pathogens of Wind, Cold, Heat, Dampness, Dryness, Phlegm and Emotion

By David Kreiner MD

April 18th, 2014 at 10:27 pm

 

credit: stuart miles/freedigitalphotos.net


Welcome, to my new world where I often feel like Robert A. Heinlein’s “Stranger in a Strange Land”.  

UnIike Heinlein’s protagonist, I am not accustomed to eating the bodies of the dead (though some natural holistic purists may consider this act the ultimate in sustainability.)  But to the previously unexposed who’ve been brought up from a Traditional Chinese Medicine (TCM) perspective, perhaps some of the Western Medical physicians’ practices may appear a bit barbaric.

In our recent Western Medical history such practices as lobotomy for psychological disorders, certain hard core diet therapies including high risk bowel resection surgery, and nearly routine hysterectomies for perimenopausal women would be considered potentially dangerous malpractice today.  However, if we thought drastic high-risk unnecessary medicine were a thing of the past, then consider the fact that excessive plastic surgery and some other unnecessary current Western therapies are more common now and have resulted in occasional deaths and disfigurement. 

Greed is a strong motivator and is one of the ills pervading our society… and the health care field has not been immune to its seduction.  Greed too often factors into determining the direction of treatment for individuals today.  Corporate greed is the reason insurance companies fail to cover many in need of health care and force physicians to see more patients than they have time to care for.  It is also a reason some providers order and perform some expensive and potentially risky tests and procedures.  

Western Medicine has had its share of iatrogenic disasters, yet I have seen many ill or infertile patients reap the benefits as a result of modern Western Medicine.  Even so, I as well as other physicians am left without answers all too often to explain or cure some of the complaints we hear from our patients.  For this reason I study TCM to learn its explanations and its treatments for some of these common ailments and complaints that elude the expertise of the Western physician.

I have been involved in the health care field for 37 years and I am quite comfortable communicating about pathogens such as bacteria and viruses and parasites and about pathophysiologic processes such as atherosclerotic heart disease, hypertension, diabetes mellitus, pelvic inflammatory disease and endometriosis to name a few.   Today, as I study Traditional Chinese Medicine, I now read and speak an additional language.  

The pathogens of TCM are Wind, Cold, Heat, Summer Heat, Dryness and Dampness, Phlegm and an individual’s emotions.  They may attack from outside the body such as wind cold (the equivalent to the common viral cold) or internally as a result of a disharmony among one or more of the organ systems.  Emotions such as Grief and sadness, anger, fear, worry and even joy according to TCM can be pathogenic when carried to an excess and lead to a disharmony of an organ system or to a blockage of the flow of Qi which can result in dampness and other pathologic events or pathogens. 

These pathogens are the “root” cause of the individual’s disharmony resulting in the manifestations or symptoms.  For example, complaints such as fever, cough, sore throat, vomiting, diarrhea, constipation, bloating, etc. ., are the result of these pathogens.  Interestingly, ancient Chinese texts refer to insects or bugs as being carried by the wind as a cause of some syndromes such as the Wind Cold referred to earlier.

There are also multiple ways to categorize and classify pathologic syndromes. They may be classified as cold or hot, internal or external, excessive or deficient or yin or yang conditions.  They may be identified as affecting one of the organ systems which are defined more based on their physiologic role from a traditional Chinese perspective rather than by their Western anatomic and physiologic identity that we learn in medical school.  There are four different layers of pathogenic attack from the most superficial to the deepest and most internal. There are even other theories of disease which may be used to classify pathology usually described as a disharmony affecting one or more organ systems.

The treatment prescription is based on the identified syndrome(s) and may be geared towards eliminating the root cause of the disease as well as the clinical manifestations and associated symptoms.  One may use acupuncture to tonify a particular weakened organ or Qi, yin or yang.  Acupuncture can eliminate heat or cold from one or more of the channels of Qi.  Or there may be excess body fluids in the form of edema, dampness or phlegm that needs to be eliminated.  Chinese herbal prescriptions are often given as an adjunct to the acupuncture to improve the efficacy of an individual’s treatment.

It does sound bizarre to this Western-trained physician, but I am impressed that the science of TCM has lasted thousands of years.  I imagine there must be something to this needling patients to modify the Qi in the body that has some benefit to the patients’ health and well-being.

I look forward to new adventures and greater understanding as I become more familiar navigating this strange land.

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Do you believe that TCM pathogens could be impacting your fertility?

 

 

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Infertility and The Greatest Gift

By Tracey Minella

April 12th, 2014 at 7:02 am

 

credit: artur84/freedigitalphotos.net


Ever wish you could make a real difference in someone’s life? A life-altering difference?  Well, you can, and you just may improve your own life in the process.

Egg donation is a gift you can give to a friend, family member, or stranger who desperately wants to conceive, but for any number of reasons, is unable to do so with her own eggs. She needs the eggs of a young, healthy, generous woman. Possibly you.

Donor egg recipients are often women who have struggled with infertility for years. Many have exhausted all other medical options to conceive using their own eggs or may have suffered the pain of repeated miscarriage along their journey. Sadly, some women battle cancer only to find that chemotherapy and/or radiation robbed them of the ability to use their own eggs to start a family afterwards.  

Egg donors are special, empathetic people.

Although they are financially compensated in the sum of $8,000, most women donate their eggs simply because they want to help someone else.

Some donors have had children and know how much motherhood means. Others may be students who aren’t ready to have their own families just yet, but want to help someone else do so. Most healthy, young women under the age of 31 can be candidates.

Long Island IVF gave Long Island its first donor egg baby. For more than two decades our Donor Egg Program has been helping donor egg recipients find the right egg donor and build their families.

If you’re interested in giving someone the ultimate gift…the chance to become a mother…and want to learn more about becoming an egg donor, including details regarding compensation for participation in the program, please contact the Donor Egg Coordinator, Vicky Loveland, RN, at (631) 752-0606 and view our website at http://www.longislandivf.com/egg_donor.cfm

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Are you, or do you know anyone who would be, interested in this opportunity? If so, please call or forward this information to others.

If you have donated… or received… eggs would you share your experience?           

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=100169597 artur84

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Femvue: The HSG Alternative Test

By David Kreiner MD

April 9th, 2014 at 5:26 am

 

image courtesy of OhMega 1982/freedigitalphotos.net


Fear can be an awesome motivator. 

Unfortunately, when it leads to avoiding a vital medical test such as investigating the patency of fallopian tubes it can prevent a physician from discovering the cause of a couple’s infertility. 

The hysterosalpingogram (HSG) is an x-ray of the fallopian tubes after radio-opaque contrast is injected transvaginally through the cervix.  Contrast can be visualized filling the fallopian tubes and spilling through patent fallopian tubes into the pelvis.

The HSG is performed using a metal instrument clamped on the lip of the cervix while a tube is placed through the cervix and contrast injected into the uterine cavity under pressure.  Patients have complained that this procedure is too painful for them to endure and either refuse to undergo the procedure or go for a surgical laparoscopy under general anesthesia.

Today, a new procedure, known as the Femvue, is available whereby a physician inserts a catheter similar to that used at insemination into the cervix.  The physician observes by transvaginal ultrasound the flow of air bubbles through the tubes and into the pelvis.  This can be accomplished in the office with typically minimal discomfort to the patient. 

Sometimes, it may be difficult to get reliable results with Femvue in obese patients. In cases where the results of Femvue are abnormal, a traditional HSG may be done to confirm results.

With the Femvue, the fear of pain experienced by some patients from the HSG is no longer an obstacle to the infertility workup.

Femvue is currently being performed at Long Island IVF by Doctors Kreiner, Pena, and Zinger.

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If you have had an HSG, was it painful? If you’ve had Femvue, how did it go?

Have you avoided an HSG because of fear?

 

Photo credit: http://www.freedigitalphotos.net/images/Diseases_and_Other_M_g287-Woman_With_Abdominal_Pain_p76296.html

 

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