The Acupuncture Approach

When breast cancer patients talk to their radiologists about radiation treatment, they discuss the potential side effects they might experience during the course of therapy. They hear about changes in skin texture, potential redness of tissue, and fatigue. What most women do not hear is how they might have chest pain after treatment. They might have arm pit discomfort, radiating arm pain, or breast tenderness that is usually mild, but for some women can be debilitating. According to Dr. Mary Barnhart, a breast surgeon in practice for over 20 years and specializing in breast cancer patients, most patients who undergo radiation therapy for breast cancer experience some level of breast pain after treatment. She believes it is a problem that is highly unreported.

Hopefully, breast cancer patients are hearing these potential “other” side effects from their radiologists. For most women, they want to know what to expect, how to prepare, and they want to know what treatments are available if they DO experience side effects from their therapy. Unfortunately, I have talked to a lot of women who never got this information. They have lived with breast pain for years, not finding any answers from their doctors, and resolving to live with the pain. Recently, I saw a patient who had radiation therapy after a lumpectomy in her right breast three years ago. She had radiating pain down her right arm and a deep aching pain in the right side of her chest. The pain affected her on a daily basis, so much sometimes that she didn’t want people to hug her. She asked her doctors multiple times over the last couple of years if there was anything she could do, but they offered her no solutions. She heard acupuncture might help with her pain, so she came in, and after six treatments, her pain was 80% gone. In two more treatments, her pain was completely relieved. She was ecstatic, and is now excited to spread the word to her other friends who are battling breast cancer!

We have talked about this before. Acupuncture is very helpful in reducing side effects for cancer patients undergoing chemotherapy treatment. A recent study out of Brazil shows that patients living with cancer experienced improved quality of life with the use of complimentary and alternative medicine (CAM). You can read an article about the study here.

So why does this matter? Because health is not just physical and quality of life is not just meeting basic human needs. It involves a measurement of social and emotional health as well. And it is all connected. When patients suffer with nausea, lack of appetite, trouble sleeping and anxiety, the impact is not just physical. There is profound impact on relationships, social interactions, and how a patient feels emotionally on a day to day basis. Acupuncture helps improve not only the physical symptoms that cancer patients experience, but also the emotional symptoms of stress and anxiety that go hand in hand with treatment. This leads to better quality of life and improved well-being. Sometimes, even one symptom-free day can make a world of difference to a patient and their family.

It’s that time of year again! See all of you Portland people there this Sunday!

Walk or run, just join in and be inspired by the thousands that are our Portland community. It is always so great to see people come together for such an important cause.

Click here to register for the race.

As a follow-up from a recent blog on post mastectomy pain syndrome, check out this article from Cancer Supportive Care Programs. Essentially, we are talking about broadening the definition of chronic breast pain to include pain caused or aggravated by chemotherapy and radiation treatments. It is estimated that 10-30% of women who have had some form of surgical procedure for breast cancer are affected with some degree of chronic breast pain, and this number is believed to be underreported.

What is imperative is that women know there are other options for pain relief. Acupuncture can make an enormous difference. I have recently been treating a patient who has been dealing with breast pain for four years as a result of a lumpectomy and radiation therapy. She was told by her oncologist she would likely always have pain, and there was not much to be done for her. She was debilitated by this pain, worn down and unable to do the things in life she loved. Treatment ensued. Her progress has been slow but steady, and she is now living almost pain-free. After four years. Women should know this…acupuncture works.

As if you needed more reasons to seek out acupuncture treatment and start walking in a new direction towards a happier and healthier life. Well, for those that need a few more:

1. Most health problems are caused by imbalances in the body. Chinese medicine (acupuncture and herbal medicine) focuses on fixing these imbalances so the body can heal itself. It brings things into balance so natural healing mechanisms can take over.

2. Acupuncture WORKS. It not only alleviates current signs and symptoms, but it helps PREVENT illness and disease. Acupuncture treats the root of the problem, not just the symptoms that are showing at the time. And acupuncture has FEW TO NO SIDE EFFECTS.

3. Western medicine and pharmaceutical drugs often focus on treating symptoms, instead of helping the body heal itself. While pharmaceutical drugs work in the acute situation, more help is need to restore the body to health for the long-term.

4. Western medicine and Chinese medicine are not necessarily opposed – they are COMPLIMENTARY! Each has its place, and togther, they can address the whole health picture of the patient. Whether your condition is acute or chronic, acupuncture can help.

5. Treatment benefits from acupuncture are like water flowing down a stream, or ripples in a pond….improvement in one area of your health will spill over and  lead to improvement in other areas. Often, patients report positive changes in areas they didn’t even know needed improving.

6. Getting treatment is just SMART thinking. It is safe, effective and cost-friendly. Treatment can help patients avoid pharmaceutical medications, surgeries and costly doctors visits, which can add up, especially in our health care system today. Less time spent being sick equals more time being productive, and a savings in time, energy and money.

Do you need more reasons? Call me. We’ll talk.

Recently, I have been treating many women for chronic pain in the breast and chest area. Most of them have had some form of breast surgery, either mastectomy or axillary lymph node dissection or sentinel lymph node biopsy (although some have chronic pain that began post-radiation treatment). This type of chronic pain is sometimes referred to as postmastectomy/postaxillary dissection pain syndromes (PM/PADPS) or post breast therapy pain syndrome (PBTPS). Although the cause of pain is not entirely clear, it is thought that it is caused by the severance of the intercostobrachial nerves, sensory nerves that exit through the muscles of the chest wall and provide sensation primarily to the shoulder and upper arm. Today, greater measures are being taken to avoid cutting these sensory nerves, but in some cases it is unavoidable. Patients have reported experiencing pain in their scar, breast, chest wall, arm or shoulder. Some describe numbness or loss of sensation down the back of the arm on the affected side, and most talk of a “pulling” sensation in the chest and arm muscles during movements in their everyday activities.

Unfortunately for patients who are affected by this type of chronic pain, there are limited solutions that conventional medicine can offer. Anti-inflammatory agents like ibuprofen (NSAIDS) or low doses of antidepressant medications are commonly prescribed to patients exhibiting this type of pain. For those with more severe pain, narcotics are prescribed, although these have been found to be fairly ineffective at treating chronic neuropathic pain. Sometimes, further surgery is recommended.

Fortunately, acupuncture is very effective at dealing with pain, and can efficiently diminish chronic pain even after a few visits. Although results vary depending on a patient’s breast care history, my clinical experience has shown that even women who have been dealing with chronic breast pain for years still have positive outcomes. Even neuropathic pain, often resulting from surgery (and even some chemotherapy medications), can be greatly reduced. Acupuncture stimulates the brain to release chemicals into the body that reduce sensitivity to pain and normalize the nervous system. It can activate nerve receptors that decrease pain signals, and can interrupt those pain signals, allowing the nerve to calm down and reduce pain. Acupuncture also increases the amount of endorphins in the body, which help reduce inflammation.

Many women also report that their pain is worse during stressful or highly emotional times, or when they feel fatigued. There are different theories as to what is happening physiologically in these cases, some that you can read in Dr. Robert A. Wascher’s article here. However, the benefits of acupuncture apply here as well, with patients reporting enormous relief from feelings of stress and anxiety, as well as an increase in energy in conjunction with their treatments. For all of my breast cancer patients, it has proved invaluable to address both the mind and the spirit, as well as their physical symptoms.

At this point, the benefits of acupuncture for women suffering from chronic pain are just becoming known. The bottom line is it is a wonderful option for relief, and there is no need to suffer.

Dry mouth is a common side effect reported by my patients who are doing courses of radiation for breast cancer. Clinically known as radiation-induced xerostomia, dry mouth usually occurs due to damage of the salivary glands during radiation therapy. Although dry mouth is most common with radiation treatment of head and neck cancer, patients may experience it for any type of radiation. Dry mouth can be  frustrating and physically painful, making eating and drinking unenjoyable. Saliva can become very thick, acids cannot be neutralized, and because there is less saliva, bacteria can hang out in the mouth causing other complications. Some patients also report a “metallic” or bitter taste in their mouths as a result of radiation treatment.

Patients often report that they don’t have a lot of options to help relieve their dry mouth. The good news is acupuncture can help ease the dry mouth and eradicate the bitter taste patients sometimes experience.  Pilot studies have been done on using acupuncture to reduce radiation-induced xerostomia with promising results, and larger studies are on the way. Clinically, my patients have reported that acupuncture helps reduce the sensation of dry mouth, and decrease the bitter or “metallic” tastes in their mouths, helping foods to taste normal again. Chinese herbs can also be very effective and a great adjunct to acupuncture, therefore, may be appropriate in some cases. It is important to avoid sugar, caffeine and alcohol, as these substances can further dry out the mouth. Smoking is also very detrimental, as it dries up fluids and contributes to the problem.

Some other helpful tips from my patients:

• Drinking club soda seems to help cut through mucous that builds up in the mouth and makes the mouth feel wetter. Drink it with meals or use it as a mouth wash.
• However, avoid sugary sodas! The teeth can be more vulnerable to cavities due to decreased saliva during radiation, so avoid sodas, juices or sweetened teas and waters.
• Keep lips moist to avoid cracking around the mouth.
• Dairy products can thicken up mucous and make the mouth feel stickier, so some patients might benefit from avoiding these during their radiation course.

Always inform your health care provider if you experience any unusual symptoms.

Note: Patients are strongly encouraged to talk with your health care professional about their specific medical condition and treatments. The information contained in this blog is meant to be helpful and educational, but is not a substitute for medical advice.

Community and integrative care are two extremely important concepts for patients dealing with cancer today. It is important to recognize that a cancer diagnosis does not mean that a patient is automatically condemned to poor quality of life. Through the use of acupuncture and Chinese medicine, and an emphasis on healthy food choices and exercise, patients can experience relief from cancer treatment side-effects and live fuller, happier lives as they battle against cancer. It begins with education, and I will be talking more about how Chinese medicine can help patients achieve a better quality of living in the midst of a life-altering situation. Patients are best served when practitioners work together in an integrative care model, and in combination, Eastern and Western medical therapies can be a powerful and effective weapon against cancer.

Can acupuncture and Chinese medicine be helpful in the modern cancer care setting? We already know the answer to this question is YES. The National Cancer Institute also agrees, and in a “Questions and Answers about Acupuncture” section on their website, you can read more about acupuncture and the various ways it can be used to help patients alleviate symptoms and side-effects of cancer and conventional cancer treatments.

To list a few important ways acupuncture and Chinese medicine can aid in cancer treatment:

• Alleviate chemotherapy-induced nausea and vomiting
• Increase appetite and improve digestive function
• Treat constipation or diarrhea
• Relieve side-effects from radiation, including dry mouth, fatigue, and radiation reactions of the skin
• Improve energy and boost immune system
• Decrease fear, stress and anxiety
• Extend survival time with cancer
• Promote overall well-being and improve quality of life for patients

Speaker Laura Rosencrantz, Certified Cancer Exercise Specialist will be talking about the importance of exercise and the role that exercise can play in the life of cancer patients. Laura is the developer and director of Inpower Fitness, a carefully designed intervention program for patients undergoing cancer treatment to help alleviate treatment side effects and help in overall recovery.

In general, it is recommended that you should walk 10,000 steps per day (about 5 miles). Wear a pedometer and keep track. You might be surprised at how much (or how little) you are moving. And it’s about the distance covered, not the time you cover it in, so don’t be intimidated by feeling like you have to break a sweat everytime you leave the house.

Walking will also increase your muscle tone, boost metabolism, ease stress, raise energy levels and improve sleep, which combined can help boost immune system and improve overall health, a huge benefit to patients fighting cancer.

Regular walking can also reduce the risk of coronary heart disease, diabetes, stroke, high blood pressure, osteoporosis and arthritis. It can help you to deal with anxiety and stress, and may reduce the risk of Alzheimer’s disease. Those are some pretty good reasons to get out and get active. Need another reason? Portland is finally starting to see the sun! Take advantage…quickly.