6.3 Conclusions

Chapter 6.3a Red flags of disease: a review

Learning points

What is a red flag of disease?

The red flags listed in this text have been defined from the perspective of a practitioner of complementary medicine. Red flags are those symptoms and signs that, if elicited by a complementary medical practitioner, merit referral to a conventional doctor. Referral is indicated because the presence of red flags indicates the possibility of a condition that may not respond fully to complementary medical treatment and/or which may benefit from conventional diagnosis, advice or treatment.

In summary, referral may be considered for the following four broad reasons:

It is important to clarify at this stage that the red flags indicate those potentially serious conditions in which the patient would be in need of further tests, advice or treatment. Complementary medical practitioners vary greatly in their opinions about the benefits of medical treatment. For this reason, some readers of this text may not agree that the presence of a particular red flag need be seen as an indication of referral. However, there is a powerful argument that patients are ideally offered the freedom of choice between treatment options. Referral for a medical opinion offers patients the opportunity to learn about the conventional medical perspective of their condition and thus the freedom to make an informed choice about its future management.

There are very few examples of when complementary medicine would not be beneficial to someone who is also receiving conventional investigation or treatment for a condition. Therefore, referral of a patient in response to red flag symptoms or signs does not mean that complementary medical treatment need be discontinued.

Non-urgent red flags

Some red flags are indicators of possible serious disease, and yet the patient does not require urgent treatment, even if the disease actually is present. An example of this is a patient who has features of anaemia, including pallor, breathlessness and palpitations on exertion. Anaemia can have serious underlying causes (e.g. chronic gastrointestinal bleeding, pernicious anaemia), some of which cannot be expected to respond fully to complementary medicine. In a case of anaemia, the patient obviously requires further investigation and, depending on the outcome of those investigations, may require medical treatment. However, if the symptoms have been developing over the course of weeks to months, the patient does not need to be seen by a doctor on the same day.

Another example of a non-urgent red flag is the child who has symptoms that indicate occasional bouts of mild asthma. In this case referral is recommended more for confirmation of diagnosis, and so that the patient can have access to medical advice about how to manage a potentially serious condition, rather than simply for treatment. It will be obvious that in such a situation the child does not need to be seen urgently.

Most of the red flags of cancer have been prioritised as of non-urgent priority. This is because such features usually have taken weeks to develop, and a delay of 1 or 2 days is not critical in the course of most cancers. In the UK, the NHS referral system is structured so that the patient demonstrating red flags of cancer is seen by a hospital specialist within 2 weeks of referral by their GP, so to be seen by the GP within only a few days of referral would be ideal in order to minimise the total wait. Of course, there will be some situations in which you will wish to make a high-priority referral for patients showing features of cancer, either because of rapidity of progression of symptoms, or in order to allay anxiety for the patient.

Those red flags that have been categorised as non-urgent will require non-urgent referral. What this means is that, in these situations, it can be suggested to the patient to make a non-urgent appointment with their GP. This means that the patient will be seen within the next few days. In this situation a letter of referral can be prepared, although this may not be necessary if the patient is capable of communicating the essential information. A letter can either be taken to the doctor by the patient (the most reliable route) or can be sent by post to the practice (more likely to be delayed or go astray). A guide to writing letters of referral to doctors is to be found in Chapter 6.3c.

Chapter 6.3b Withdrawing from conventional medication

Learning points

A review of the action of drugs on the body

This first section of this chapter on withdrawal from conventional medication reviews the physical and energetic effects that drugs are understood to have on the body. These effects were first described in Chapters 1.2c and 1.3b.

The energetic effects of drugs on the body

It was explained in Chapter 1.3b that drugs can affect the energetics of the body in one or more of the following ways: cure, suppression, drug-induced disease and placebo. Table 6.3b-II illustrates the predominant energetic effect that may be associated with therapeutic results for each of the nine categories of drugs grouped by physical action in Table 6.3b-I. Table 6.3b-II does not mention the placebo effect, as this is likely to have some positive impact to some degree in all therapeutic prescriptions.

Table 6.3b-II Energetic interpretations of the therapeutic effects of drugs according to the nine modes of drug action

Category Mode of action of drug Energetic interpretation of therapeutic effect
1 Replaces a deficient substance that is normally obtained from the diet
2 Replaces a deficient substance that is normally produced by the body
3 Kills or suppresses the growth of infectious agents
4 Counteracts the damage caused by toxins Cure
5 Toxic to rapidly dividing human cells Suppression
6 Specifically stimulates the immune response by the introduction of an antigen
7 Other drugs that artificially stimulate natural bodily functions Drug-induced disease or suppression
8 Suppresses natural bodily functions Drug-induced disease or suppression
9 Other drugs that directly counteract the symptoms of a disease process Suppression

The three energetic effects that are most relevant to the withdrawal of prescribed medication are those of cure, suppression and drug-induced disease. When a complementary medical practitioner is faced with a patient who wants to withdraw from conventional medication, it is valuable first to take some time to consider which of these three effects may be most relevant for the patient.

Withdrawal from suppressive medication

Chapter 1.3b proposes that suppressive drugs are those that treat the manifest symptoms of a condition without dealing with the root cause. One drug that is suppressive according to this definition is salbutamol, which when inhaled can be remarkably effective in relieving an attack of asthma. Salbutamol is known to act by means of stimulating the cellular receptors (beta receptors) in the bronchi and bronchioles, which normally respond to the action of the hormones adrenaline and noradrenaline. By acting at a chemical level, this drug induces a bodily change, in this case relaxation of the smooth muscle that encircles the lining of the small airways in the lungs. This is how salbutamol causes relief of symptoms. However, by suppressing the asthma, the stressor that has caused the asthma attack, which may actually be a combination of diverse factors such as environmental triggers and emotional disturbance, has not been removed. With symptomatic treatment such as salbutamol, the stressor is likely to remain, and so may possibly cause more subtle or intransigent symptoms at a later date.

It makes sense then, that when suppressive medication is withdrawn, suppressed symptoms may well return. This can occur almost immediately, as would be the experience of the asthmatic who becomes wheezy once he or she has come to the end of their supply of salbutamol. However, this return of symptoms can be delayed. For example, following the withdrawal of some treatments, such as at the conclusion of cancer treatment, the suppressed symptoms (in this case the cancer) do not return immediately, and may even not return at all. According to the theory of suppression, this is explained by the supposition that the original imbalance is still likely to be present, but is now expressed in a different way in the body, such as in the form of depression, or that the imbalance has been rectified by a different means, such as modification of harmful lifestyle factors. A move towards greater balance, therefore, may be accompanied by a recurrence of the original symptoms at a later date. However, a subsequent move towards balance need not always result in recurrence of the original symptoms.

It is important to acknowledge that this idea of suppression springs from complementary medical theory. In contrast, the conventional medical view is that when a drug causes suppression of symptoms this has no lasting deleterious effect. The idea that an imbalance can be pushed away from the surface only to emerge in a different part of the body is not considered within the conventional medical approach.

From an energetic perspective, replacement therapy is an unusual example of a long-term prescription drug. In the case of some forms of replacement therapy (e.g. insulin in type 1 diabetes), the patient cannot survive without the drug. Although the replacement therapy certainly suppresses symptoms, it has been argued in this text that it cannot be described as energetically suppressive. Because there is no doubt that replacement therapy always returns a patient to a more balanced state, then it has to be described as curative in nature.

To summarise, withdrawal from a suppressive drug might be expected from a holistic perspective to have the following consequences: recurrence of the original symptoms either immediately or at a later date, or persistence of the original imbalance expressed in some way at a deeper level. In some cases there might be no symptoms because of total resolution of the original imbalance, but this would only be expected if the patient had been making some positive emotional and lifestyle changes while taking the drug.

Drug dependence

It is recognised that there are some drugs that cause the body to change in such a way that the patient comes to be reliant on the presence of that drug for a ‘balanced existence’. What this means is that, if the drug is withdrawn, the patient will experience a range of symptoms which, at least temporarily, will disturb their normal ability to cope with the stresses of everyday living. This effect is known as ‘drug dependence’.

Drug dependence may manifest primarily in the physical body. For example, withdrawal from certain types of antihypertensive medication can lead to a dangerous rise in blood pressure. It is as if the body has ‘forgotten’ how to control blood pressure within a relatively safe range. This type of dependence is termed ‘physical dependence’.

Other drugs seem to have effects that are more pronounced in the emotional and mental realms. For example, withdrawal from nicotine can lead to a syndrome of psychological symptoms, including cravings for nicotine, irritability, insomnia and anxiety. This aspect of dependence is termed ‘psychological dependence’.

In reality, the distinction is not that clear-cut. Withdrawal from drugs of dependence will usually lead to a constellation of physical and psychological symptoms.

The mechanism of drug dependence

To understand what is happening to the body in drug dependence it is helpful to consider the chemical changes that might occur in response to a drug. Conventional pharmacology describes the response of the body to a drug in terms of adaptation. Many drugs act by mimicking the action of one or more of the natural chemicals of the body. These natural chemicals include the hormones and neurotransmitters that connect with receptor proteins on the surface of certain cells to effect a physiological change. The drug salbutamol acts in this way, as does cortisone (an artificial corticosteroid hormone).

If a drug is present in the body for some time, in many cases the body adapts to its presence by reducing the production of the natural chemical that the drug is mimicking. For example, in the case of a long-term prescription of cortisone, the adrenal cortex ceases to produce the normal amounts of natural corticosteroids. In fact, the tissue of the adrenal cortex actually becomes wasted in someone who is taking a long-term prescription of cortisone. This adaptation is potentially fatal if the artificial cortisone is withdrawn suddenly. The shrunken adrenal cortex is no longer able to respond rapidly to produce the level of corticosteroids necessary for a healthy response to stress. From an energetic perspective, this bodily change is a clear example of drug-induced disease.

Other drugs stimulate the body to counteract their effects by increasing the number of protein receptors on the cell membranes of the tissues at which the drug is acting. This means that more drug is required to have the same effect as time goes on. This situation, known as ‘tolerance’, is very important to understand from the perspective of drug withdrawal. If tolerance to the drug has developed, then on withdrawal the normal levels of the body chemicals that act at those tissues will be insufficient to effect a healthy response. Opiates (including morphine and heroin) are drugs that are known to induce a state of tolerance. Whether used medicinally for pain relief, or illicitly for their psychological effects, increasing doses of opiates are required over time to generate the same effect. It is well recognised that opiates mimic natural body chemicals, including the endorphins. As tolerance develops, it is believed that the numbers of cellular endorphin (opiate) receptors in the body increase. On withdrawal, the body is simply unable to produce sufficient quantities of natural endorphin to stimulate the increased numbers of receptors in the body, and the complex syndrome of opiate withdrawal is experienced.

Tolerance is, of course, a particular aspect of drug dependence. Once a person has become tolerant to a drug, withdrawal is very likely to lead to unpleasant symptoms. The development of tolerance is another example of drug-induced disease.

Oct 3, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Conclusions
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