Leishmaniasis: A curious worm, herbal treatments and a historical perspective

Leishmaniasis is an interesting illness that has infected and affected the world for millennium. It is nearly ubiquitous throughout the planet with only Australia and Antarctica being free from its tiny clutches. Leishmaniasis is a small protozoan with many different species creating a very extended family. It can infect our organs, skin, and mucous membranes. We get it from close contact with infected animals as well as from little sandflies. Human spread has been shown via blood and sexual contact.

Leishmaniaisis is relatively uncommon in developed countries, however with the war in Iraq and Afghanistan some soldiers have been returning with cutaneous leish. The curious attributes about leishmaniasis is that it can be very difficult to treat, it is usually asymptomatic, and it typically resolves on its own but not before causing terrible scarring especially if it infects the face.

History shows that over the last 3000 years, humans have not been able to whip this worm. Egyptians describe it in their papyrus. The shamans of Sudan have been using an herbal medication from the Garad tree for hundreds of year. More recent studies suggest that some Garad tree preparations may help with fighting this flagellate. The Ancient Mayans noted a significant rate of occurrence. They treated it with local herbals, incantations, confession of sins and penitence and daily baths. Other herbal preparation found in Brazil, the Yucatan, and Iran have been described with varying results from small studies.

Modern medications seem to work the best, however as they are good killing the leish they are also killing are own cells and can be toxic to our bodies. As a result, they are not used for any extended period of time and they are highly controlled by the FDA and CDC.

In conclusion, if you live in a western developed country you most likely won’t have to worry about his little guy unless you travel to an endemic area. If you are signing on for military service, 3^rd world infections are not one of the selling points from recruiters. However, for reassurance, most of the cases returning from Iraq seem to be on the extremities. As for treatment, I would go with the good stuff, good old modern medicine, but only for short a short period of time. The Mayans most likely had it right; take a daily bath, ask for forgiveness and pray for it to go away sort of like warts. If you do have any questions, please consult with your primary care doctor.

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Prostrating the Prostate; Traditional Medicine, Alternative Treatments and Historical tid bits

The prostate has been the bane of men’s existence for millennia. Eventual ly nearly all men will have to reckon with it. If we do not give it the attention that it needs, it will no doubt remind us. Usually this means visiting our friendly primary care practitioner to get the dreaded prostate exam. As far as exams go, a simple prostate exam is not the worst exam. Females go through much, however this has never quelled any mens’ misgivings.
The prostate is an interesting organ. It works great for the first 40-50 years of our life. The prostate provides nutrients and protects our potential potentiates (sperm) and it doesn’t bother us. About the time that sex begins to slip from the number one spot in a man’s world, the prostate rears its enlarged head. This is when I see men in my office with symptoms of being unable to fully empty their bladder, awakening at night multiple times urinate, and the age old statement of “Doc, it takes me near twenty minutes to go to the john”.
The word prostate is derived from “prostates” first used by Herophilus in 300BC. Prostate in Greek means, “to stand before” and as Herophilus saw things, the prostate stood before the testes. Apparently the prostate does not like to play second fiddle and has caused many more common problems than our unsuspecting testicles ever did. One of the most common problems that we encounter is benign prostatic hypertrophy, otherwise known as BPH. BPH is benign enlargement of the prostate. As a result of the prostate’s close proximity to our ureters, an enlarged prostate can compress our ureters and cause urinary problems.
Through history, medicine has devised a number of different ways to treat BPH. We first learn of prostate treatment from the ancient Egyptians written on medical papyrus in 1500 BC. Egypt treated urinary retention by attempting to “force out the urine” using Crocus, Abu plant, berry of the Uan tree, fresh gruel, linseed, uam seeds, duat plant and water. How does that fresh gruel sound? No very appetizing. Ambrose Parè in 1575 is credited with performing the first definite operative prostate procedure, which is our basis of endoscopic prostatic surgery today. Now I ask you, is that treatment or torture? Our treatments has significantly improved since that time using state of the art endoscopic cameras, precision tools and anesthesia to make the procedures much less unpleasant.
Modern traditional medicine has medications that help shrink the prostate and they work well. These can be obtained from your doctor. Of course these medications have side effects but most people tolerate them pretty well. Complementary and alternative medicine has a multitude of different treatments that have been used. The most common is Saw Palmetto, which is an extract from a fruit berry. It is used throughtout the world to treat BPH. It is used much more often in Europe than the US. Studies on Saw Pametto are contradictory with some showing that it improves symptoms and other studies showing that it doesn’t improve symptoms. Pygeum africanum is an extract of bark from an African plum tree and has shown to improve symptoms two times more frequently than placebo. However there are not many studies on Pygeum africanum. Herbal medications such as these two can also cause side effects so please speak with your doctor if you plan to use these.
In conclusion, the prostate is an inevitable irritant that most men will have to endure. However, as positive reassurance, most men die with their prostate problem and not from it. We also have many good forms of treatment both traditional and alternative medicine that are available. I would try Saw Palmetto first as its side effect profile seems a little better than the traditional medications. If this does not work, then traditional medicine is a very good option. Historic treatments seem less desirable and are probably very uncomfortably. I don’t think I would ever want to eat ancient Egyptian gruel. Either way, please talk with you doctor as all medications whether natural or synthetic can cause interactions with other medications.

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Health, Holistic Medicine and History

Before I write any further, I want to explain my thoughts on Health, Holistic Medicine and Historical musings. Much of what I will write is not new and has been written before, but I want to define my thoughts.
Health is a state of being. It is a very fluid state and is always changing. Health encompasses the physical body and the emotional, mental and spiritual states. During our day to day and week to week lives these four aspects of health flow in and out of each other in varying degrees of importance like a scattered meshwork. In a person who is healthy, these four aspects of health remain within the middle of a relative stable range. Due to the interwoven nature of health, when one facet is ill or needs healing, the others are also affected. More severe illness occurs when we have multiple components that are ill. Sometimes one very scarring experience can affect our emotional state and drag the rest of the pieces down manifesting as a severe systemic illness. I have also seen patients who have multiple apparently unrelated illnesses causing an overall decrease in the quality of life and health
Holistic medicine encompasses the four different facets of health. A holistic practitioner understands and applies this knowledge. If one part of our health is ill, then the cause may be found in one of the other aspects of health. Many patients I see who have multiple illnesses or chronic illnesses such as chronic pain have had a history of emotional trauma. Studies show that a history of childhood abuse is a risk factor for chronic pain as an adult. It is also important to know that one aspect of a person’s health may be strong and can be used as a crutch for temporary support. An example of this would be a patient who I saw a while ago whose spiritual life was solid, but who was diagnosed with cancer. He had a very large and strong Hawaiian family. They were excellent long board surfers and a number of his sons were professional surfers. In Hawaii, surfing is more than just a day at the beach, it is a way of life that defines and represents a families ancestors and the spirit of Hawaii. Surfing was a very spiritual act for the family and he took strength in just talking it. He and his family leaned on their spiritual life for guidance, strength, and support. The holistic practitioner who understands and utilizes this gives the patient the best chance at healing and having optimum health.
As with any lesson learned, we can’t forget the challenges and answers those who came before us overcame and discovered. Medicine in the beginning had only the spiritual to give them answers. As knowledge of medicine was passed from one great culture to the next our scientific knowledge increased, but we lost some of the spiritual component. With each passing age, we slowly lost the subtleties and intuitiveness of healing. With the advent of modern medicine; antibiotics, immunizations, x-rays, there was less need for the practitioner to use unscientific and unproven means to heal. Modern medicine has magnificent ways of studying the body through spectacular imaging to very precise molecular biology techniques to detect illness. We have terms such as “evidence based medicine” and “double blind placebo controlled trials” that have thrusted medicine into another age of better and safer treatments. However, it leads us to forget the subtle intuitive nature that can help provide better overall care. We can’t forget the past or we may need to relearn it over again.

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Practical Foundation

I am a physician trained in traditional allopathic medicine. I am a board certified Family Medicine practitioner and have had an excellent public education my whole life. I learned hard science and a multitude of medical facts through focused and intense study in medical school. Medical residency training gave me an outstanding hands on experience that transformed me into a medical practitioner. Through my education, I have gained much knowledge about how to help and treat people.

I grew up in a circle of family and friends who were open to health care beyond allopathic medicine. My beliefs and medical practice have been shaped by this circle. I have gained many experiences not learned in school that have helped to mold my practice. I have come to believe that holistic and integrative medicine that includes complementary and alternative medicine is a better answer.

Medical school and medical residency training instill the “disease centered approach” as opposed to the “patient centered approach”. As our science improved, our patient skills deteriorated. Recently, the momentum is beginning to shift the other way and the medical community has realized that patients want something different. We are listening and we are starting to change our ways. Patient centered care is now taught in medical schools and residency. Doctors are graduating better doctors not because they know more medicine but because they strive to know the whole patient. We can still endeavor to do much better.

An integrative approach to medicine that includes our cutting edge science and information technology, complementary and alternative forms of medical treatment, and discovering subtle emotional and spiritual cues can best lead to treating the whole individual. This blog will cover a holistic approach to health with an eye on history. I will look at traditional treatments, complementary and alternative medicine options and the historical approach from past cultures to help answer how to best treat the physical, emotional, mental and spiritual components of an individual.

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