Pudsey Pindoctor

How to describe Mongolia ...

2011-06-16T20:45:00.000-07:00

... without using tired cliches?

It's been a while since my last blog post, and as some of you will know, I've been preparing for a long while to visit Mongolia to find out more about the country's traditional medicine.

Now I'm here, in Ulaanbaatar, the country's capital, and wondering how I can give a feel of the place for those of you who have never been.

Westerners who write about the country tend to use a number of very tired, very obvious cliches.

Cliche 1. Ulaanbaatar is a city of contrasts where shining new towers to capitalism rise above broken pavements, and sharp-suited executives pass by penniless herders forced to the city to beg following years of drought and harsh winters ...

... well the penthouse vs pavement analogy has always been overdone. Mongolia is a developing nation, and doesn't have a lot of spare money for infrastructure. While there are indeed contrasts - some of them quite significant - Mongolians on the whole seem quite an egalitarian nation, and where they can, people look after each other more than I've seen in England.

Cliche 2. Ulaanbaatar's potholed roads throng with motor cars, filling the air with a stifling petrol haze, and being driven with a carefree lack of attention to safety that owes more to Mongolia's celebrated passion for horseriding ...

... Mongolians like horses ... now they drive cars like they ride horses ... clever analogy, geddit? No, it's just another cliche. There's certainly a lot of cars, and they do indeed contribute to a lot of pollution in the air. People aren't always able to afford maintain them to standards we might take for granted in NW Europe. Many of the roads are quite potholed - I think it's an unavoidable consequence of damage caused by harsh winters and lack of funds for infrastructure. That means people have to drive quite creatively if they want to preserve their suspension.

Cliche 3. Ulaanbaatar, where the face of Chinggis Khan, who led his people to conquer one of the largest land empires in world history, gazes down from almost every public building and billboard ...

You do see quite a lot of Chinggis Khan in marketing literature, statues and tourist tat. After the end of communist rule in 1990, the government intentionally promoted Chinggis Khan as a figure of national pride and national unity, hence the public statues. It's not surprising there's a lot of tourist tat with him on it - for many people, 'Genghis Khan' is the only thing they know about Mongolia. That, and a strange belief that it's full of yaks (scratches head). However, Brits, of all people should understand the complexities behind any nostalgia for past imperial 'glory'.

So what would I say?

Most of my visit has involved research into Traditional Mongolian Medicine (TMM). I've seen some very knowledgable and helpful people and monastery clinics and the national university. They've been kind enough to give me bags of useful stuff to write up and learn from.

I've done a lot of walking around, since I've not really fancied making use of the ubiquitous informal taxi system in UB. Most places I need are in under 40 mins walking distance, though it can feel like more on a hot day. There's a lot of building works going on throughout, and a lot more businesses have spring up since I was last here in 2004.

There's also a lot of piety for the Buddhist religion, which has been re-emerging following years of state suppression under communism. As a result, there are even chains of vegetarian restaurants starting to spring up around the city (Try out 'Loving Hut' if you're over here at all - tasty, affordable and vegan if that's an issue for you. They make a lot of use of 'mock' meats, but do it quite well. They're funded by one of the Buddhist sects.)

I've not been able to get out of UB this time, which is a shame. The capital hosts about 45% of the country's population, but is only a tiny spec in a vast and varied country. I have a feeling that the hearts and souls of many Mongolians lie outside the city, even if the city is where they live. However, someone wiser than I would need to answer that properly.

One unusual thing for half the time I've been here has been some epic thunderstorms. I know a lot of people have welcomed them, since the country has been suffering from severe drought. Let's hope the weather is starting to take a turn for the better.

I'll write a bit more about the medical side of things when I feel inspired.

Lies, Damned Lies and Headlines (or why acupuncture is so safe)

2010-10-29T07:13:00.001-07:00

I nearly leaped out of my chair in alarm the other day when I read a headline in The Guardian 'Dozens killed by incorrectly placed acupuncture needles'. How on earth, I wondered, had that happened, since I know how scrupulously safe professional acupuncturists are?

It is also completely at odds with the York Acupuncture Safety Survey, published in the British Medical Journal in 2001, carried out by Hugh McPherson of York University, which looked at nearly 35,000 treatments carried out by professional acupuncturists in the UK. The survey did not uncover a single serious adverse event (ie, something requiring hospital treatment) Even minor adverse reactions were rare - just 1.3 per 1000 treatments - most commonly fainting or nausea. To me, this seems pretty damn safe.

On reading the Guardian article, I quickly found out that the screeching headline was entirely misleading, and designed to create disproportionate alarm.

The article was based on a recent paper by Edzard Ernst, professor of complementary medicine at the University of Exeter, entitled Deaths after acupuncture: A systematic review. Ernst's paper indicates that worldwide, since 1946, there have been 86 deaths in which acupuncture was the probable cause, the vast majority of which were in China or Japan.

The causes of death Ernst lists include punctured lungs, or complications from the use of unsterilised needles. He says this shows the importance of adequate training for all acupuncturists.

Professional acupuncturists in the UK use only sterile single-use needles

So let's put this in perspective.
1. Throughout the whole world, there have been only 86 reported deaths from acupuncture in the last 64 years, though I would guess there will have been millions of acupuncture treatments over the same period.
2. Of that tiny number of deaths, most took place in China or Japan. China, certainly, during much of this period could not be classed as a developed nation, so the conditions of treatment or the provenance of the practitioners in those tiny number of fatalities is a matter of legitimate scepticism.
3. Nobody, but nobody makes use of re-usable needles anymore. They are all single-use sterile needles that come in blister packs from proper suppliers. You couldn't get the other sort if you tried, and who would? Seriously.
4. Needle training 101 for acupuncturists is to only needle at a shallow angle over the lungs, and to avoid needling completely if people are very thin, or there's the slightest risk. We take the safety of patients very very seriously.
5. Pretty well anywhere you go in the developed world, professional acupuncturists will belong to reputable professional organisations, such as the British Acupuncture Council, with strict requirements for training and professional skill. I myself had to study for three years and spend large amounts of time in clinic under supervision before I was qualified to practice. I still have to maintain continuous professional development to keep my skills and knowledge up-to-date. Acupuncturists are not dangerous cranks, they are trained committed professionals.

So ... if I look at the reality of professional standards in the UK and elsewhere, together with the weighty support of evidence for safety in McPherson's study, and set it against the rather contrived sense of alarm running through the Guardian article about Ernst's paper, and make a considered judgement about the safety of acupuncture, I know what conclusion I would make.

Acupuncture is demonstrably safe.

I hope you will agree.

An apple a day, or the pindoctor's chutney project

2010-09-17T08:24:00.000-07:00

You can definitely tell the season is changing. The weather has turned, and all around Pudsey, and throughout Leeds, no doubt, fruit trees are begging to be picked before their contents go to waste.

I have the same issue myself every year with my apple tree. Here's a picture I just took of it:

It produces billions of the most wonderful eating apples every year, which utterly surpass my ability to consume, even when I pack bags of them for my friends.

This year though, I've been on a mission to preserve as many of them as possible, and have spent the last couple of weekends on a chutney-making extravaganza.

Here's a couple of good recipes you might want to try out.

Classic English Apple and Date Chutney
This is based on a special recipe handed down to me from Ma Sneath, my friend Dave's late mother, who was wise in the ways of chutney.

It's a lovely blend of sweet and sour tastes, which is just the kind of thing Chinese medicine advises for Liver/Spleen disharmonies - the kind of digestive disruption people often get when they are stressed.

Makes about 2.5 kilos
Ingredients:
2 Kg tart eating apples
0.5 Kg dried stoned dates
1 Kg onions
2 garlic cloves (optional)
2 chilis
0.5 Kg stoned raisins or sultanas
1.25 litres vinegar
0.4 Kg soft brown sugar (you should add another 0.15kg if you're using cooking apples)
1 to 2 level teaspoons salt
3 level teaspoons ground ginger
2 level teaspoons cinnamon
1 level tablespoon pickling spice; 6 cloves and 1 small bay leaf, all tied together in a muslin bag.

Method:
1. Peel core & slice apples
2. Peel & slice onions. Peel garlic
3. Coarsely chop apples, dates, onions, garlic, chilis and raisins/sultanas.
4. Put into saucepan with half the vinegar (preferably a non-metallic one)
5. Cover and simmer until fruit and vegetables are tender – about 30 minutes.
6. Add remaining ingredients and stir until sugar dissolves
7. Cook, uncovered, on a medium-low heat until the chutney thickens to a jam-like consistency, stirring occasionally (this probably takes a couple of hours, depending on your cooker settings)
8. Remove bag of spices then pot in sterilised jars and seal with a vinegar-proof lid.

This chutney is best left a month or two to mature somewhere cool and dry.

Hot South Indian Apple Chutney
I adapted this from a recipe using star fruit in Julie Sahni's excellent book Classic Indian Vegetarian Cookery.

It's a hot and vibrant chutney, redolent of the tastes of southern India. It's gorgeous in its own right, but from a Chinese medical point of view, it is just the sort of thing you'd want to pep up your meal in the early stages of a cold, to help you put on a sweat (Chinese call this 'releasing the exterior' which helps flush out pathogenic factors and invigorate the body's natural defenses when you are being attacked by an 'external Wind invasion'). I like this so much, I have difficulty waiting for the jars to mature!

It's definitely one for those who like heat though - not for anyone with a delicate digestion, nor those suffering from any condition which makes them feel hot or flushed, because the chili packs a punch.

Makes 450ml
Ingredients:
700g tart eating apples, peeled and cored
1 tablespoon of salt
2 tablespoons of cayenne pepper
1 teaspoon of turmeric
3/4 teaspoon ground asafoetida (you can easily get this at most Asian grocers, where it's usually kept in yellow plastic pots. Ask for 'Hing'
1/2 teaspoon of ground fenugreek seeds
125 ml light sesame or light vegetable oil (I usually add a couple of drops of the more easily available oriental dark sesame oil to ordinary vegetable oil)
1 teaspoon of black mustard seeds

Method
1. Finely chop or food process the apples and mix with salt in a non-metallic bowl.

2. Blend the cayenne, turmeric, asafoetida and fenugreek in a bowl, and set aside next to your cooker.

3. Heat the oil in a small enamel or non-metallic pan on a medium/medium hot heat. When hot, add the mustard seeds, and cover with a lid until the popping and splattering of the seeds subsides.

4. Add the mixed ground spices in one go, and give a quick stir, then immediately add the apples.

5. Lower the heat to medium and cook for 10/15 minutes or until the apples are reduced to a spicy pulp and the oil has begun to separate. The chutney should be bubbling throughout, and you'll need to keep stirring so it doesn't stick and burn.

6. Pot in sterilised jars and seal.

This one is ready to eat immediately, but like most chutneys, will benefit from being left to mature for a few weeks.

Horses, not zebras

2010-08-10T08:10:00.000-07:00

One of my favourite medical sayings is 'If you hear hoof beats, look for horses, not zebras', first coined by the renowned American surgeon Dr. Ben Eiseman in the 1960s. It's an aphorism that was frequently drummed into me when I was training in acupuncture.

What this means is that common conditions are common, and rare conditions are rare, so a practitioner should usually resist the temptation to immediately diagnose a rare and unusual illness if there is a more common condition that matches all the symptoms.

We can all probably be grateful for this wise advice - just think if you had a GP whose first assumption was that your mild headache was a brain tumour, your nosebleed was early onset Ebola, or your rumbling tummy was a sure sign that an Alien was about to burst out of you. In almost all cases, it would scare the living daylights out of you, and be wrong as well.

In the past, the only people who usually had to have their diagnostic enthusiasm restrained were medical students. However, in the age of the Internet and Google searches, we have a new legion of cyberchondriacs, typing their symptoms onto a search bar.

And when they do so, they often find zebras, not horses. A good friend of mine was asking me last week what might be the cause of the strange bitter taste in his mouth after eating. A google search had taken him to a website where one person had attributed his symptoms to eating pine nuts.

"Well, Bob" (not his real name), I said. "Have you been eating a lot of pine nuts recently?"

"No," he replied. "Probably not that then." I said, stroking my chin. "Do you have any heartburn or acid indigestion?" "No." Have you been on the razz, sleeping poorly and eating badly recently?" "Oh yes, most definitely!"

"In that case, it's most likely to be the taste of bile, and the result of overdoing it. Western doctors used to call it biliousness, and Chinese medicine calls it Liver Fire. The first thing you should do is rest, eat properly and cut back on the booze, and only think of further treatment if it doesn't clear up."

"Damn ... cutting back on pine nuts would have been a lot easier!"

Definitely a case of dealing with horses ... not zebras.

Of course, rare conditions do sometimes happen, and the art is to recognise their unique characteristics when they do, but in most cases, the most obvious explanation is usually the right one.

A Rhapsody in Brown (or why you shouldn't be embarassed by your bowels)

2010-07-30T06:35:00.000-07:00

Acupuncturists are fascinated with bowel movements. Any time you visit a practitioner, prepare to be asked searching questions about how often you go, when you go, whether your stools are loose or dry, or whether there are any unusual colours, smells, noises or other factors.

Why do we ask? Well the most obvious reason is it will tell us the state of your digestion, which is often a root factor in a host of other health issues. It is also not unusual for non-digestive health issues to have a knock-on effect on your digestion and defaecation.

One of the more frequent examples of this is that when we are run-down, are stools tend to be looser, and when we are stressed out, they can often dry out to little pebbles. In conditions like irritable bowel syndrome (there are different names for it in Chinese medicine, but IBS is familiar to most people), you will often see alternating diarrhoea and constipation.

Some people like me are quite happy to answer detailed questions about all manner of bodily functions, including bowel movements but I have no shame.

Others find it harder to talk about for a whole variety of reasons.

One thing I have often found helpful is referring people to a handy chart of stool consistency called the Bristol Stool Scale:

This is a handy way of bypassing discussions of 'how loose is loose', so that you can quickly identify where people are on the scale and get down to making a diagnosis and discussing a treatment plan.

It's also a good way of impressing your GP when you visit her. If she asks you 'how are your number twos today?' you can reply 'actually, it's more of a number three at the moment, though I had a six last week after a dodgy kebab.'

On the subject of colour, if your stools are bright red, it often indicates bleeding in the rectum. If they are a tarry black, it could indicate bleeding in the stomach or oesophagus. In either case, it's usually a good idea to visit your doctor to find out what's happening.

That's why I was more than a little alarmed a couple of months back when I turned to flush away that morning's offering, and saw it was bright maroon. After a moment's blind panic, I realised it was unlikely to to be the sign of a bizarre terminal illness, and a lot more to do with the beetroots I'd eaten the night before. D'oh!

Bon Appétit.

Pindoctor heal thyself

2010-07-28T02:30:00.000-07:00

Of course, the thing about my own simple and eminently sensible advice about good sleep (zero marks for modesty today PP!) is that I need to take it myself sometimes.

Staying up until 1am reading my book is probably not the most sensible way of getting a full night’s sleep.

(I blame Steven Erikson for being too damn interesting. Dust of Dreams is his latest.)

Note to self: I must remember to write something on the use of pressure on the acupoint Zusanli to pep up your energy levels when tired. It’s the little hollow between the tibia and fibula about three inches/4 finger widths below the eye of the knee. Not advised if you’re pregnant though! Fortunately I'm not.

Sleep - how difficult can it be?

2010-07-23T04:34:00.000-07:00

I often see people who have difficulty getting a good night's kip, and bad sleep can have a major effect on their quality of life.

I've certainly had those days and nights myself - lying in bed, with my brain refusing to switch off, followed by days feeling like my skull has been packed with cotton wool, and hoping nobody asks me to do anything clever or complicated.

Now Chinese medicine has loads to say on the subject of sleeplessness, and practitioners like me are always fascinated in the details of how an individual's insomnia manifests (there's books and books written on the subject, and I may go into further detail in a later post.)

But before we look at the bells and whistles, let's get the basics right. It often surprises me how many people overlook or are unaware of some of the fundamentals of restfulness.

1. Do you have a regular pre-sleep ritual? Something that gives a clear break between what you do when you're awake and what you do when you're ready for bed. For me, I try and make sure that there’s no distractions in the bedroom like PCs/TVs, and I have a half hour or so of reading before I sleep. Sometimes I’ll have a glass of hot or cold milk. Many people find a quick bath or shower before they get into bed is nice. It’s basic, but it does make a difference. Do something that allows you to wind down before you switch off the lights.
2. Try and get your evening meal out of the way two or three hours before bedtime so that it’s reasonably digested before you try to sleep. Unless you're a sleeping superhero, eating that chicken vindaloo with rice, naans and samosas five minutes before you get into bed will disrupt your sleep.
3. If you wake up, don’t fret about waking up - just accept it. Maybe get yourself a glass of water or milk, and read a bit more of your book until you feel tired (if you have a partner, try not to wake them up while doing this ... a dis-chuffed partner can also be a cause of sleepless nights!). Don’t make agonising about not being able to sleep one of the factors that’s keeping you awake.
4. Think about eye-shades or earplugs if light or noise are physically-controllable factors in the waking up.
5. A strong cup of coffee before bedtime really won't help (though a friend of mine swears blind to the contrary!) If you have difficulty sleeping, avoid caffeine in the evening, and think hard about cutting it out altogether.
6. Finding time for regular exercise on top of a busy life can be tough. It helps though.

If anyone else has any simple advice for good sleep, let me know.

Welcome to my blog

2010-07-23T03:55:00.000-07:00

While it may sound strange, I woke up this morning, drew open the curtains, looked out of my window at the sun-dappled leaves of the trees in Fulneck and Tong Valley (the view from my window is great!), and thought 'Gosh! I really need to start a blog!'

So here it is ... the start of what I hope will become a shared compendium of my thoughts and your contributions on health, and life and stuff (particularly the stuff!)