Complementary Medicine in the Care of the Kidney Cancer Patient

1. Cedars-Sinai Medical Center December 9, 2013 Complementary Medicine in the Care of the Kidney Cancer Patient Los Angeles, California Lucy Postolov, L.Ac. Master of Traditional Oriental Medicine Diplomate in Acupuncture (NCCAOM) Allied Health Professional for Cedars-Sinai Medical CenterBoard Certification in Integrative Medicine

3. Integrative Medicine is a part of Modern Medicine • Mainstream Medicine • Allopathic Medicine • CAM • Complimentary and Alternative Medicine

4. NCCAM Groups CAM ModalitiesInto Five Major Domains • Alternative Medical Systems • Traditional Oriental Medicine and Homeopathy • Mind-Body Intervention • Meditation, Imagery, Relaxation • Biologically-Based Treatments • Herbals, High-Dose Vitamin Therapy, Enzyme Therapy • Manipulative and Body-Based Approaches • Massage, Yoga, Chiropractic, Micro Currency treatment • Energy Therapy • Qi Gong, Reiki,Therapeutic Touch

5. Five Major Domains

6. Why Patients Use Alternative MedicineResults of a National Study Recent studies in the United States and abroad support the prevalent use of alternative health care. For example, a 1994 survey of physicians from a wide array of medical specialties (in Washington State, New Mexico, and Israel) revealed that more than 60% recommended alternative therapies to their patients at least once in the preceding year, while 38% had done so in the previous month. 47% of these physicians also reported using alternative therapies themselves, while 23% incorporated them into their practices. Conclusion: Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life. JAMA, 1998;279:1548-1553, John A. Astin, PhD, The Stanford Center for Research inDisease Prevention, Stanford University School of Medicine, Palo Alto , Calif.

7. An Increasing Number of Cancer Patients are Turning to Complimentary and Alternative Medicine (CAM) CAM use among cancer patients is diverse and varies by region • National Center for CAM estimates • 7-54% of cancer patients use CAM • 48-88% of cancer patients used CAM while being treated in comprehensive cancer centers in the USA

8. How Acupuncture Works The Eastern Philosophical Point of View

9. How Acupuncture Works The Western Medical Point of View These are several consecutive transaxial slices from single-photon emission computed tomography scans of patient 2 with baseline scan (top row) showing initial thalamic (thick arrow) and basal ganglia (thin arrow) asymmetry with the right activity greater than the left. The postacupuncture scan (bottom row) shows normalization of the thalamic and basal ganglia asymmetry, with the both right and left having relatively equal activity. From Cerebral Blood Flow Effects of Pain and Acupuncture: A preliminary Single-Photon Emission Computed Tomography Imagining Study. Andrew B . Newberg MD, Patrick J. LaRiccia, MD Brunde Y. Lee, MD, John T. Farrar, MD, Lorna Lee, MA, Abass Alavi, MD

10. Kidney Organ in Western Medicine

11. Kidney Organ & Meridian in Chinese Medicine

12. The Function of Kidney Meridian • To Store Essence • Dominate Human Reproduction & Development • Dominate Water Metabolism & Reception of Qi • Produce Marrow to Fill Up the Brain • Dominate Bone • Manufacture Blood • Manifest in the Hair • Open into the Ear • Dominate Anterior and Posterior Orifices …Chinese Acupuncture & Moxibustion

13. Clinical Applications of Acupuncture for Patients with Kidney Cancer Post Surgical (Removing of the Kidney) • Pain • Cryosurgery • Radiofrequency Ablation • Nausea • Loss of Appetite • Constipation

14. Clinical Applications of Acupuncture for Patients with Kidney Cancer Side Effects Related to Target Therapy • Mucositis • Diarrhea • High Blood Pressure • Anemia • Nausea • Vomiting Radiotherapy Induced Symptoms • Skin Irritation

15. Other Symptoms as a Result of Biological Therapy • Insomnia • Skin Reaction (rash or swelling • Headache • Muscle Ache • Fatigue • Mood Disorder • Feeling a Loss of Control • Loss of Appetite

16. NIH Consensus Development Panel on Acupuncture • Promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations, such as addiction, strokerehabilitation, headache, menstrual cramps, tenniselbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful. JAMA. 1998;280:1518-1524

17. Other Symptoms as a Result of Chemotherapy Toxicity Other Symptoms CNS Toxicity • Insomnia • Fatigue • Mood Disorder • Feeling a Loss of Control Loss of Appetite Weakened Immune System Alopecia

18. Acupuncture helps tolook and feel beautiful after cancer related treatments • Facial Rejuvenation • Weight loss OR gain • Return of sexual desire • Gain the energy back • Balance of hormones • Micro Currency TX

19. Risk of Harm Associated with Non-Conventional Approaches to Cancer Management • Symptom control of nausea and vomiting should be initiated after underlying causes have been identified • Claims to “cure” cancer with natural and non-toxic treatment • Herb-drug interactions • Side effects associated with unsafe and unregulated non-conventional interventions

20. Requirements for Acupuncturists Working with Oncology patients • Acupuncture License • National (optional) • State (required) • General Medical Training Background • Hospital System Experience • Good Communication Skills • Experience Treating Oncology Patients

21. Chinese Herbal Medicine to Support Patients Going Through Chemo and Radiation Bu Zhong Yi Qi Tang RenShen Ginseng Rx. Bai Zhu Atractylodis Alba Rz Huang QiAstragali Rx Dang GuiAngelicaeSinensis Rx Dao ZaoJujubae Fr. Chen Pi CitriReticulatae Pc. ChaiHuBupleuri Rx. ZhiGan Cao Glycyrrhizae Rx. Preparata Sheng Jiang ZingiberisRecensRz Sheng Ma CimicifugaeRz.. Chemo-Support Huang Qi Radix AstragaliRen Shen Radix Ginseng Ling Zhi Ganoderma Xi Yang Shen Radix Panacisquinquefolii Mu Dan Pi Cortex Moutan Zhi Mu Radix Anemarrhenae Fu Ling Poria Chen Pi Pericarpium Citri reticulatae Mai Men Dong Radix Ophiopogonis Dang Gui Radix Angelicae sinensis Ban Xia Rhizoma Pinelliae Preparatum Lu Gen Rhizoma Phragmitis Nu Zhen Zi FructusLigustrilucidiShaRenFructusAmomi Huang Jing Rhizoma Polygonati Gan Cao Radix Glycyrrhizae uralensis Radio Support Huang Qi Radix Astragali Dang Gui Radix Angelicae sinsis Hong Hua Flos Carthami tinctorii Dan Shen Radix Salviae miltiorrhizae Shou Wu Radix Polygoni multiflori preparata Gou Qi Zi Fructus Lycii chinensis Wu Wei Zi Fructus Schisandrae Nu Zhen Zi FructusLigustrilucidi Zhi Mu Radix Anemarrhenae Mu Dan Pi Cortex Moutan Gan Cao Radix Glycyrrhizae uralensis Sheng Di Huang Radix Rehmanniae Chen Pi Pericarpium Citri reticulatae Yu Zhu Rhizoma Polygonati odorati

22. Dang Shen- Radix Codonopsis pilosulae Promotion of phagocytosis Daily administration of decoction enhanced reticuloendothelial phagocytosis Hematologic effect Oral and intravenous use of Dang Shen in normal rabbits caused an increase in red blood cell count and hemoglobin. Immunologic effect Dang Shen inhibited the febrile reaction to toxins such as turpentine in mice and rats. Anti-ulcerative effect Pre-treatment with the decoction of the herb reduced the incidence of ulcers in rats due to stress of pylorus ligation. Analysis of Individual Herbs in Chemo Support

23. Bibliography • Maciocia, Giovanni, The Three Treasures Newsletters Autumn, 1999 • Perry M, Anderson C, Dorr V, Wilkes J, The Chemotherapy Sourcebook, Williams & Wilkins, Baltimore, Maryland, 1999. • Skeel R, Handbook of Cancer Chemotherapy, Williams & Wilkins, Baltimore, Maryland, 1999 • Zhu YP, Chinese Materia Medica, Harwood Academic Publishers, Amsterdam, 1998. • Bensky D and Gamble A, Chinese Herbal Medicine Materia Medica, Eastland Press, Seattle, 1993. • Chang H.M. and But P.P. Hay, Pharmacology and Applications of Chinese Materia Medica, World Scientific, Hong Kong, Vol. I, 1986., World Scientific, Hong Kong, Vol. I, 1986. • Dorsher PT, “The Neuroanatomic Basis of the Acupuncture Principal Meridians”, Mayo Foundation for Medical Education and Research 2009 • Harris RE et al.“Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on µ-opiod receptors (MORs)”, Elsevier Inc. 2009 • Cohen, Lorenze and Markman, Maurie. Integrative Oncology. p126. Huston, TX. 2008 Humana Press. • Kathleen K.S.Hui, Jing Liu, Niko Makris, Randy L. Gollub, Anthony J.W. Chen, Christopher I. Moore, David N. Kennedy, Bruce R.Rosen, and Kenneth K. Kwong. “Acupuncture Modulates the Limbic System and Subcortical Gray Structures of the Human Brain: Evidence From fMRI Studies in Normal Subjects”, Massachusetts, 2000 • Andrew B . Newberg MD, Patrick J. LaRiccia, MD Brunde Y. Lee, MD, John T. Farrar, MD, Lorna Lee, MA, Abass Alavi, MD. “Cerebral Blood Flow Effects of Pain and Acupuncture: A preliminary Single-Photon Emission Computed Tomography Imagining Study.” American Society of Neuroimaging. 2004 • Lahans, Tai, ‘Integrating Conventional and Chinese Medicine in Cancer Care’ 2007 • Deng Liangyue, et al. “Chinese Acupuncture and Moxibustion” 1987 • Gabriela E. Garcia, Sheng-Xing Ma, and LiliFeng “Acupuncture and Kidney Disease” Advances in Chronic Kidney Disease, Vol 12, No 3 (July), 2005: pp 282-291

25. In The Battle of the Disease There are Three Warriors…