Chinese Breast Cancer Patients, Capstone Project Example

Introduction

Because I am a massage therapist, my background is in Non-traditional medicine. For most, a massage therapist is not a “real doctor”. I own my own clinic and practice holistic health. I have an acupuncturist working with me and find his work very fascinating. So much so, that I now take treatments a couple times a week to keep me mentally and physically grounded. Non-traditional healthcare practices and medicine have been on the rise recently due to so many people suffering from chronic illnesses (Lee, 2006). Contrary to older beliefs that non-traditional medicine involved witch-craft and other forms of sorcery, many people feel it is a healthy alternative or compliment to modern medicine. Non-traditional medicinal practices are usually community and culturally linked, which makes it readily available and easy to access. Many non-traditional practitioners prescribe their clients herbs that can come in a powder, capsule, or its natural form, salves, tonics, and other forms of medicine that they would not be prescribed by a traditional doctor. Many cultures have been practicing non-traditional healing for centuries. People from these various cultures have brought their traditional medical practices to the United States, and those practices have been adopted and or added to modern traditional medical practices. As a result, clinicians of today must be aware of the different cultural values and how these cultural beliefs may affect person’s choice of healthcare practices. Many factors affect a person’s culture, including, but not limited to, education, socio-economic, region of birth, and age (Abdullah, 2003). One of the greatest challenges that American healthcare professionals face is cultural issues when diagnosing and treating patients from other cultures. American healthcare providers approach diseases by assuming that some external factor has caused the illness, while non-traditional medical approach tends to be centered on the whole body.  Non-traditional medicine has stood the test of time and continues to be used and trusted by many.

TCM (Traditional Chinese Medicine)

Through this course I have had to decide what my passion is. I know that TCM is my passion because I have seen firsthand how much of a difference it has made in the lives of so many. Traditional Chinese Medicine or TCM is considered non-traditional medicine to many Americans (Cassidy, 1998). TCM is a system of that is grounded in two major principles: Yin and Yang. In order for a person to live a happy healthy life, several components must be in harmony. With this belief, harmony means health, nice weather, fortune. On the other hand, disharmony means disease, disaster, and bad luck. The purpose of Chinese medicine is to restore harmony for each person (Cassidy, 1998).  Herbal medicine is an important component of TCM. The Chinese use herbal medicines to restore the body’s natural balance. These methods have been used for centuries to treat illness from arthritis to dementia. Many of their herbal supplements come in the form of raw herbs that can be taken internally or altered to make balms or tinctures that can be used externally.  Acupuncture is one of the better known TCM’s. With this type of therapy, tiny needles are inserted into specific points on the patient’s body. It is believed that certain parts of the body are energy channels and by inserting needles into these specific areas will generate free flowing energy to the mind and body. Acupuncture is also used as a form of preventative medicine that helps to treat muscle pain, headaches, anxiety, depression, and gynecological issues (Cassidy, 1998).

Benefits of Non-Traditional Practices

One of the greatest benefits of non-traditional medical practices is its holistic approach. This really appealed to me because my background and degree is in holistic medicine. The idea of holism is that the person’s physical body is not the only portion of a person affected by illness. An illness can affect a person’s mental and emotional state being. Consequently, treatment should not just focus on illness in the physical form, but it should address all areas of the individual. Under the holistic view, it is believed that a person can take responsibility for the creation of good health and the alleviation of pain. It is believed that the doctor is just a facilitator for positive changes and that the patient has more effect on their health by changing their mindset (Cassidy, 1998; Abdullah et. al, 2003). Another great benefit of non-traditional medicine is the relief of pain-both physical and emotional. Many clients have reported that it produces calm and relaxing state of being without the fear of becoming drug dependent (Mason, 2008). While others have reported a feel of wellness, balance, and wholeness because they felt more connected to their physical and mental bodies (Lee, 2006). In one study, women undergoing chemotherapy who were battling breast cancer reported that improvements in the side effects they were experiencing after trying one or another form of non-traditional medicine (Lee, 2006). According to the study, the use of non-traditional Chinese medicine along with other forms of traditional medicine greatly improves the quality of one’s life. Nearly half of the participants in the cancer study reported that they felt modern medicine was superior in treating their cancer, but believed that using non-traditional methods in conjunction with it produced even greater positive outcomes. Many of the women reported that they used Qi Gong (a type of energy healing) after using traditional cancer treatments. They believed it help their bodies to recover from the harsh chemicals and may prevent the cancer from recurring (Lee, 2006)

Acupuncture and Moxibustion

More often than not, acupuncture is used in conjunction with moxibustion-the burning of the herb Artemisia Vulgaris. When the herb is burnt, the smoke must penetrate the underlying part of the body. According to this practice, there are 500 pressure or energy points on the body and only 10 to 12 points can be used for each treatment; however, different points can be changed during the duration of a treatment (Mason, 2008). Many cancer patients have noted the benefits of using TCM in conjunction with other medical methods. A number of patients have reported having more energy while taking traditional chemotherapy methods (Mason, 2008). One study conducted by Robertshawe (2008), found that patients who were battling cancer and utilized acupuncture and acupressure relayed that their fatigue was less severe. Another study showed that patients using non-traditional methods of treatment reported that their intensity and duration of chronic complaints decreased (Cassidy, 1998).

Why Choose Non-traditional Medicine

Patients chose non-traditional medicines for many reasons. A person’s cultural and spiritual beliefs play a significant role in his/her choice to use non-traditional approaches to diseases and ailments. Every culture has a set of beliefs about what causes illnesses and how it can be treated and cured. For example, Hispanics have a strong heritage that dictates what is acceptable and what is not. Many of them share a fatalistic view of health and believe that illness is God’s will or a type of divine punishment brought on by sinful behaviors. Likewise, Native Americans believe that a person’s health is determined by his/her harmonious relationship with nature. They believe that illnesses are brought on by supernatural forces and usually seek the advice of a shaman or medicine man. These cultural differences affect the patients’ perspective about medical care (Mason, 2008). Unfortunately, healthcare workers have hoped that people from cultural diversified communities would convert to mainstream medical practices. These barriers have complicated medical treatment for these individuals.   Many view non-traditional treatments as a safer method that has fewer adverse side effects.

Why TCM for Diabetes

Traditional Chinese Medicine is a healing system. It originated thousands of years ago, but has evolved into a well developed system that focuses on preventing and treating illness. Within this system, several modalities are used in the treatment and prevention of illness and disease. Acupuncture/ moxibustion, herbal tonics, diet and body exercises are the most common employed therapeutic methods of TCM. Because diabetes is usually a combination of the previous mentioned factors, TCM has had great success with treating and controlling the disease. Traditional Chinese Medicine offers a holistic approach to treating any disorder. The use of Traditional Chinese medicine has been around for thousands of years. Chinese medicine is centered on the belief that there is a universal energy called chi, which is present in every person. This energy flows through the body in pathways called meridians. Many believe that when the flow of this energy is blocked it will cause illness (Agras, Crow, Mitchell, Halmi, & Bryson, 2009).  When TCM practitioners evaluate patients with diabetes, they complete a multi-system observation to gain insight about the patient’s overall state of health. This observation may include observing the shape, color, and coating of the patient’s tongue; the patient’s hue of skin; body or breath odor, and the quality of the patient’s pulse.

Diabetes

There are three types of diabetes-Type I, Type II, and gestational diabetes. Type I comprises about 5-10 percent of all cases of diabetes. Gestational diabetes is identified during pregnancy, but is a temporary condition. Blood sugar levels return to normal after pregnancy.  Diabetes is a chronic that causes an imbalance in the sugar levels and insulin production in the body of a person with this illness. More than 20 million people will be diagnosed with diabetes during their lifetime. Of these 20 million people, 90 percent of them will have type II diabetes. (Ham, Kruger, & Locke, 2009). Complications from diabetes can lead to heart disease, obesity, and high blood pressure. Type II diabetes is six time more likely to affect minority groups, such as African American, as compared to non-minority groups. According to the U.S. Department of Health and Human Services, African Americans are twice more likely to be diagnosed with any form of diabetes than Caucasians. Race is a major risk factor of diabetes. Diabetes is also common among groups that live in poverty, but proper intervention and lifestyles changes can decrease the rate at which it affects member of the African American population. Over the years, diabetes has been treated as t medical condition; however, genetics and individual choices play a large role in the prevalence of the disease. This notion of the disease has caused the increase and continued prevalence of the disease. Type II diabetes is the most common type of the disease, but it is usually not diagnosed until severe complications arise. About one third of people with diabetes went undiagnosed for an extended period of time.  Intervention for the disease must incorporate cultural features, address specific social and physical aspects of the African American community, and provide early intervention through education, lifestyle intervention, and food environment.

Research/Theory

Health behaviors tend to be influenced by one’s income and educational background. Many studies have looked at how poverty affects diabetes. The relative deprivation theory is fitting of many cases where African Americans are affected by diabetes. Relative deprivation occurs when person objectivity towards health is impaired as a direct result of their financial situation. Statistically, African American head of house hold typically earn about 20,000 dollars less than Caucasian households (Adler & Newman, 2002). The poverty rates of African American are about 24.5 percent. According to the deprivation theory, African American have unequal access to the following: healthcare practitioners, awareness of diseases, risk factors, increases exposure to psychological stressors, low economic status, structural limitations, limited access to fresh fruits and vegetables, lack of ability to afford healthy foods, lack of health promoting behaviors, cultural perceptions of excess weight, and family history (Ham, Kruger, & Locke, 2009). Consequently, people from this economic status often eat foods that are high in carbohydrates, sugar, fat, and other unneeded additives. Yet a great way to minimize the effects of these unhealthy foods is to use a good exercise plan to boost metabolism. With TCM, practitioners believe that extra body weight is caused by an imbalance in the body due to the spleen or liver not working properly. Practitioners will target those specific areas with acupuncture. In one study, participants began seeing weight loss within the first week of treatment (Cassidy, 1998).

Many risk factors must be considered when examining diabetes. Obesity is one of the greatest indicator if diabetes. Type II is the most prevalent type of diabetes in the United States. Many factors can lead to developing diabetes- age, obesity, and lack of physical activity, race, and eating habits. According to statistics groups of minorities (African Americans, Hispanics, Indians, some Asians, and native Hawaiians) have a very high risk of developing type II diabetes.  Many of these risk factors are associated with culture and heath behaviors.  Healthy diets and exercise, cultural beliefs about weight and weight management, cooking methods, access to health care facilities, and their perception of the health care provider plays an important role in the control and prevention of diabetes in minorities (Boardman, Onge, Rogers, Richard & Justin, 2005). The greatest prevalence of overweight is seen in minority groups. Members of minority groups are 10 percentage points more likely to overweight than non-Hispanic whites (Ham, Kruger, & Locke, 2009). There is even a higher prevalence for African American women. For example, in 2001-2008, “20- to -39 year old Non- Hispanic Blacks women were seen to have a 70.3% prevalence rate of obesity and overweight, while Non-Hispanic whites were seen to have a prevalence of 49%. More than 50% of African American women over the age of 40 are obese and over 80% overweight. The prevalence of extreme obesity in African American women was more than twice that of White and Mexican” (Ham, Kruger, & Locke, 2009). Chinese acupuncture ear stapling is another method for losing weight. This process involves targeting points on the ears that are believed to control food cravings. This process has also shown success with cigarette and heroin addiction. One study conducted on 20 women who were considered obese found that this type of TCM in conjunction with a 2000 daily calorie intake and 15 minute daily walks helped each woman to lose and average of 10 pounds during the study. The women were aged 22-42 and were members of minority ethnicities. Those women who participated in all parts of the study, but did not use the TCM only lost about three pounds. Those women who did receive the TCM reported a decrease in daily appetite (Cassidy, 1998   ).

One study conducted addressed the effectiveness of intervention programs in African American communities. This study was conducted to give insight into the cultural and health views of African Americans. One noted change that positively affected and improved the prevalence of diabetes in this community was exercise. There seemed to be a link between social and health perception among African Americans in this community. The research has indicated that African Americans are more likely to live a healthier lifestyle if there is a change within their environment. (Ham, Kruger, & Locke, 2009). The evidence has revealed that when a person realizes the relationship between exercise, proper diet, and stable glucose level can have a positive effect on the overall health. Many people who suffer from diabetes are plagued by chronic pain called neuropathy. For this particular type of symptom, acupuncture has shown some proven relief. For example, many researchers have speculated that acupuncture helps the body release natural painkillers that reduce the symptoms of neuropathy. A study was conducted using 200 people suffering from neuropathy. Of those participants, more than 77 percent said that acupuncture improved their sleep patterns and reduced the pain they felt on a daily basis-while about 33 percent of them said that acupuncture eliminated their need for daily pain medications. Consequently, acupuncture is a possible solution for those suffering from diabetic nerve pain. Once the pain has been eliminated, these victims will be able to began exercising and lose weight (Boardman, Onge, Rogers, & Richard, 2005   )

Much literature suggests that African Americans do not partake in much physical activity because of their perception of body weight. This particular study examined the health benefits of African Americans who participate in physical activity as little as once a week. Along with this study, participants were also educated on nutrition. The findings concluded that learning about the food pyramid and how food consumption affects the body along with moderate exercise had a great impact on the degree or extent of problems due to diabetes. Body image across cultures varies greatly. African Americans perceptions of their bodies are affected by cultural values, society influences, media influences, and what is considered beautiful or attractive to members of the same culture. For example, evidence support the fact that members of African American culture are more tolerable or even prefer heavier bodies. In one study conducted on high school teens reported that more African American girls wanted to gain weight than teen white girls of the same age. Also, more African American girls gained weight because their parents had expressed to them that they were too thin (Two Feathers, 2005). The positive perspective and widely acceptance of heavier bodies among the African American population has created a high tolerance of overweight and obese members of this culture. The perception can form an attitude that being heavy or overweight is normal. Among adolescent girls African American girls are twice as likely to be overweight than white girls (Two Feathers, 2005). Yet, there are some factors that people may face that have very little to do with proper exercise, diet, or even positive image. TCM addresses what is called physical constitutions. This entails those characteristics that one may have inherited. Some people may have a great appetite, but remain slim and in appropriate proportion, while others may not have as great an appetite, but gain weight immediately. TCM speculates that there are certain types of food one should eat based upon their body type.  TCM called this functional foods and it correlates with their five elements theory. “The five elements correspond to different aspects of the natural world and the body” (Cassidy, 1998   ).

Researchers have concluded that body image is established fairly early in life. So, in order to target great health, being overweight must be stressed to adolescents as well as adults. Lowering one’s chances of being overweight will drastically lower one’s chances of developing diabetes.  According to Two Feathers, et al, “Because there is an inherent mind-body connection, body image is at the heart of acupuncture theory and practice. TCM can be very effective in supporting who have suffered from an eating disorder and preventing others from developing an eating disorder by targeting emotional imbalances, mental insecurities, and spiritual challenges” (2005) If overweight members of the African American community are seen as been normal, there is no motivation for adolescent members of the African American culture to control their weight. For example, many African Americans girls stated that they had been taught to ignore weight related comments and were not motivated to change their poor eating habits due to them. (Nwasurua, Osuagwu, & Bae, 2007). Through the teachings of TCM, these very same girls can be taught the importance of maintaining a balance. Regardless to color or ethnic group, many adolescent view themselves as being immune from health problems and may not take preventative measures seriously (Nwasurua, Osuagwu, & Bae, 2007). Weight intervention and prevention must address both children and adults.

Analysis

In the United States about 30 percent of the population is considered to be obese (Ham, Kruger, & Locke, 2009). The obesity rates among African Americans are exceptionally high. About 66 percent of African American women are overweight and 79 percent of African American men are overweight. African American men over the age of 20 are four times more likely to be obese than Caucasian men of the same age. These statistics are due partly to the way African Americans prepare their foods and the types of food they consume. Another study found that African Americans said that the way prepared their foods the same way they grew up eating them. (Two Feathers, 2005). This suggests that being overweight can be linked to cultural eating habits. TCM is designed to give diabetic patients alternatives to traditional Western medicine. Often TCM is used in conjunction with other methods. Many TCM gradually control blood sugar and eventually reduce the need for insulin therapy over time. Through this recovery, the pancreas will slowly regain its function eliminating the need of insulin.

Socioeconomic status can also result in poor health habits which can lead to type II diabetes. This factor is a major contributor to the high prevalence of type II diabetes in African Americans. Many African Americans reported that they rarely consider the health benefits of a food product when they purchase it. They are more concerned with the quantity of the product to ensure that they will have enough to feed their families for a period of time. Many African Americans in low income families are providing for their families on a fixed income. Consequently, they often buy foods that are less healthy because they cost less. “A low socioeconomic status contributes to certain lifestyle factors that can play a role in the prevalence of diabetes” (Two Feathers, 2005).

Incidence                                                                                                                             

Globally, more than 150 million people are afflicted with type II diabetes. Fourteen million of those are in North America. This number is expected to increase by 24 percent by 2025. Today, diabetes affects about 7 percent of the United States population and is the sixth leading cause of death. Some complications of diabetes are damagage and malfunction of kidneys, nerves, heart, eyes, and blood vessels (Boardman, Onge, Rogers, & Richard, 2005). Diabetes can also affect the feet and many people have limbs amputated due to progression of the disease. In addition to these progressive disorders, diabetics can encounter diabetic ketoacidosis and hypersomolar which are the result of a biochemical imbalance. Infections such as pneumonia and influenza are very dangerous for people with diabetes because they are more likely to die from these illnesses than people who are not suffering from diabetes. Diabetes is also associated with increased risk of heart disease and stroke. In 2008, more than two thirds of all heart related deaths were diabetes related (Boardman, Onge, Rogers, & Richard, 2005). Also, nearly 75 percent of all adults with hypertension also have diabetes (Boardman, Onge, Rogers, & Richard, 2005).

A chronic illness can threaten a person’s self-image. Often when a person is diagnosed with a chronic formulate future identities of failure. As a result, when a person is diagnosed with a disease like diabetes, they often set goals that they feel are achievable by someone who has the disease. In other words, the person outlook on life changes after diagnosis. However, the person’s perception of the disease is often linked to the progression of the disease. According to Two Feathers, there are varying degrees of acceptance and denial that comes along with the diagnosis of a chronic illness. The five stages are denial, anger, bargaining, depression, and acceptance. Some people remain in denial for an extended period of time. They refuse to accept their diagnosis (Two Feathers, 2005). This refusal is usually accompanied by a refusal to accept medical attention for the illness.  They add, “For most individuals, denial will gradually fade into acceptance. Denial is healthy so long as it serves as a protective function in the short term. Denial can result when a patient is conflicted or uncertain about how the illness will be incorporated into their life” (Two Feathers, 2005). Culturally, African Americans seem to view illness as a weakness, as a result, many tend to ignore warning signs and refuse treatment after being diagnosed. Denial is just one of many strategies used to manage uncertainty.  Some clinicians even categorize uncertainty as an unorganized illness because it can remain after the person has been diagnosed (Boardman, Onge, Rogers, & Richard, 2005).

Morbidity and Mortality

Diabetes is a major cause of premature illness and death in many countries. Many of the deaths are related to cardiovascular disease, which is directly linked to diabetes. These disease causes damage to blood vessels. General complications from diabetes causes about a third of the world’s deaths (Boardman, Onge, Rogers, & Richard, 2005).  Close to four million people between the ages of 20-79 can be attributed to diabetes. This number can be compared to the deaths of several infectious diseases combined. Countries with the highest number of diabetes are: The United States, China, India, and Russia. Women with diabetes have a higher chance of dying from the disease than men (Boardman, Onge, Rogers, & Richard, 2005).

Promoting Healthy Living

During this class, my professor promoted healthy living as a barrier against all forms of illness. Consequently, I know that I will continue to promote that within my practice. Lifestyle measures are effective in preventing and delaying onset of type II diabetes in African Americans. To help prevent diabetes a person needs to achieve and maintain a healthy body weight. In order to do this, one must become physically active for at least 30 minutes a day. One should exercise regular or moderate activities several days a week. More activity will be needed to lose weight and when a healthy weight is established a common pattern can be established to maintain the desired weight. Healthy food choices must be made daily. This is a gradual process that must be done over time and not “cold turkey”. People who attempt a lifestyle change overnight usually fail (Ham, Kruger, & Locke, 2009). Fruits and vegetables servings can be used in place of snacks such as chips or candy. Many people do not realize that tobacco can increase the risk of cardiovascular diseases. If one is a smoker, it is best to eliminate this from one’s life. This process may require the help of a healthcare provider. However, if one has already been diagnosed with diabetes, there are lifestyle changes that can help to control the disease and in some cases reverse it. Early diagnosis is the key. If one has family history, weight issues, or any other indicators that he/she could possibly be at risk of getting the disease, he/she should be testes. Testing is done by using a small blood sample. Often, organizations help to promote healthy living and disease control. Many communities have facilities or centers that offer free screenings and educational information. Once one has been educated about the disease, he/she can control it or prevent it. Studies show that people who venture into a healthy lifestyle change or weight loss journey do better when they have a partner. Seventy-seven percent of people who attempt to make a life style change did so with a partner (Ham, Kruger, & Locke, 2009).  Finally, Ham, Kruger, & Locke say intervention programs work by focusing on population-wide approaches to promote healthy diet and regular physical activity, thereby reducing the growing global problem of overweight and obesity.

Analysis

Nontraditional medical practices have been around for centuries and don’t show any signs of disappearing any time soon.  During this class, I have had the opportunity to research and learn more about acupuncture and its uses. After trying it for myself, I am convinced that it makes a great difference in the overall mental and emotional well being of the person.  People choose non-traditional methods for various reasons, but the choice is mostly influenced by cultural background. Acupuncture, acupressure and herbal supplements are the most widely used forms of non-traditional methods. Diabetes is a chronic disorder that can have devastating effects, but it is controllable and preventable. Practitioners of Traditional Chinese Medicine promote proper diet and physical activity as imperative to eradicating the disease. African Americans are particularly prone to the disease because of many cultural barriers. In recent years there has been a great increase in the prevalence of the disease. In order to eradicate this disease, families, communities, and cultures must share information and assist each other in the battle to healthier, more productive lives. Growing in a community where health is maintained by whatever means necessary is very important to me.  Some people have never heard of Traditional Chinese Medicine.  I believe that through adequate communication many lives can be saved by promoting TCM as an alternative to many forms of Western medicine. It is important for healthcare providers to understand their patients’ health care needs; it is equally important for patients to understand healthcare providers’ diagnoses and treatment recommendations. “Communication barriers can relate to language, culture, and health literacy” Based upon the information I have presented and that I have studied this school term, I feel strongly that Traditional Chinese Medicine as an approach to treat diabetes and its debilitating affects is a must. Treating the patient from a holistic view is, in my opinion, the best way to cure the problem. Diabetes has many underlining causes that are not addressed by Western medicine practices. A final study I looked at concluded that through TCM treatment in conjunction with other therapies, ninety-two percent of the patients that participated regained the proper function of their pancreas and were no longer in need of insulin therapy (Cassidy, 1998   ) Although this study consisted of only 12 patients, I believe that data is phenomenal. In my practice, I intend to offer TCM to my patients.

References

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