Doctors speaking a different medical language with a 70% overlap

posterior tibial nerve stimulation

I spoke with a medical doctor, a women’s urologist, the other day about a mutual client. The discussion was frustrating for both of us, with disagreements about what I thought were perfectly obvious physical characteristics.  Afterwards it hit me that we were speaking different languages with enough overlaps that we didn’t realize there were  two different sets of definitions.  For those of you going between two practitioners with different paradigms or for practitioners of Chinese or Naturopathic medicine who need to communicate with medical doctors, I thought I’d write about this.

The situation was about an older client suffering from incontinence that had worsened in the last years, finally including at night.  She had very low abdominal muscle tone and abdominal folds, with weight distribution shifting significantly upon rising, at which time urinary urgency would increase.  Six months earlier she had an ultrasound to see whether her uterus was pressing on her bladder.  The ultrasound did not show that but it was taken while she was horizontal and she commonly felt pressure while vertical, subject to gravity.  She also had urodynamic studies that stimulated a worsening of her problem.  She was interested in referral for urological physical therapy and a kind of medically accepted acupuncture called Posterior Tibial  Nerve Stimulation in which a 34 gauge needle is inserted deep into the Spleen 6 point and a point near Spleen 4 and attached to electrostimulation. In Chinese medicine terms she had Spleen and Kidney deficiency with Phlegm Damp accumulation.

Our mutual misunderstanding was not due to confusing Chinese medicine organ systems or meridian functions with those of the similarly named western medicine organs. (By convention when the organ terms are capitalized when referring to Chinese medicine and lower case when referring to western organ characteristics.) The confusion can be an issue in people  who are unaware that the Spleen meridian includes liver and pancreatic functions or that the Kidney meridian function includes adrenal gland activity.  Or that the Chinese medicine terms are technical and work within its own system.

Uterine prolapse in western medical terms

First, since the client’s belly sags significantly, I suggested that organ prolapse was contributing to her urinary urgency.  “I’ve looked.  She has no prolapse.”  Were we talking about the same woman?  In Chinese medicine prolapse would mean the organs are sagging, not held in firmly, exerting pressure on the bladder, gut, the blood supply or straining the lower back.  In western medical speak, the prolapse of the bladder would cause bulging of the vaginal walls and a uterine prolapse would cause the uterus to fall into the vagina and eventually out.  In Western terms it refers to a much later stage than in eastern terms. It sounded like we were using the same language but we were not.

Next I mentioned that the client reported that the catheterization used in her urinary tests had caused damage to her urethra for a while. (This was not performed by the doctor in question.) The client immediately went from urinating 10 times a day and night to urinating 20 times, lasting for a month then eventually diminishing after I gave her herbs.  This was a major factor in her preference for Chinese medicine.  The doctor flatly denied that it could happen, even though it happened within a day after her urine tests. The doctor thought the sudden increase was a coincidence. I can only imagine that “damage” to the doctor meant more than blunt force irritating tissue enough to increase urinary urgency

These uterine displacements are included in uterine prolapse in traditional nonwestern medicine- it would be considered version by western MDs.

The next term we understood differently was invasive.  The doctor knew about tibial nerve stimulation but thought that treatment with needles every week for 12 weeks would be terribly invasive.  To me, taking an oral medication that disrupts your physiology is much more invasive than inserting a couple of acupuncture needles attached to an electro-stimulation machine.  In western medicine anything that breaks the skin is considered invasive.

 Side effects of anticholinergic drugs to stop urinary urgency like Vesicare can include dizziness, depression, lower leg edema, fatigue, cough, pharangitis, blurry vision, confusion, hallucinations, high potassium (which can slow heart beat) and hypertension according to  Side effects to acupuncture needles on Spleen 4 and 6 consist of possible bleeding or bruising. I have clients who come weekly for a lot more than 2 needles because it makes them feel well.  So which is really more invasive?

However Tibial Nerve Stimulation is not the standard of care until someone “fails” oral medication.  Standard of care might sound like it means “best sequence of treatment” but really it is a creation of the insurance industry that combines cost considerations with consensus medicine, assuming that most patients react similarly.  (Since Tibial Nerve Stimulation is assumed done through a medical doctor it is charged at a higher rate than when done by an acupuncturist, and certainly costs more than a pill which may not be covered by insurance.)  I define “the standard of care” to refer to the best treatment for an individual and avoiding medication with clients sensitive to side effects.

The idea of people speaking with closely overlapping languages which they may not realize are different is not my own.  Deborah Tannen has documented it between, parents and children (You’re Wearing That?) men and women (You Just Don’t Understand) or between people of different social classes.  Basically you think words mean the same thing to both of you, but that the other is not quite bright, or assertive or supportive.  Look for similar issues between yourself and people in different professions, patients and practitioners and people from other walks of life.


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