WORKING WITH BREAST CANCER PATIENTS

AN INTERVIEW WITH BARBARA MAHLER Dipl.Ac., Dipl. C.H.,
BY MOLLY GREACEN Dipl.Ac.

Molly: Barbara, I wanted to talk with you about your experiences in working with women with breast cancer. I thought it would be interesting to share with other practitioners, many of whom perhaps have not had any experience in this field. Tell me how you got involved in doing this work.

Barbara: I started working with breast cancer about six years ago, working with women who were suffering from the side effects of chemotherapy, because I felt that this suffering was unnecessary. In Chinese medical school, I learned that it was very important that women get support going through chemotherapy and radiation, and not be left so toxic and sick after these therapies. And that was why I was so interested in working with breast cancer.

M: What school did you go to?

B: Emperor’s College in Santa Monica.

M: What are the side effects in terms of Chinese Medicine?

B: Nausea, vomiting, anorexia, menstrual irregularity or drug induced menopause, low blood count, hair loss, bladder problems, mouth sores, ulcers, rash and nail changes are some of the side effects. In addition, the drug, adreamiacin, has a lifetime limit due to its potential to injure the heart muscle. It can also cause problems with the liver, kidneys and peripheral nerves. To give you an idea how hot and toxic it is, the warning on the label on the package states that contact with the skin can causes severe burns. Additionally, within 14 days of its first use, the patient will consistently lose their hair.

M: How can Chinese medicine help someone going through cancer therapy?

B: In China they frequently use an integrated approach, and studies indicate that the combined approach has increased survival time by 50% over using either medicine alone. I can’t over express the value of Chinese Medicine. Without the support of Chinese Medicine, patients are left to their own devices to revitalize their Wei Chi, nourish their blood, clear extensive blood and chi stagnation, as well as deficiency, and rebuild any Zang Fu that may have been injured. There is still a certain amount of damage, even with using Chinese Medicine, but not as extensive.

M: Give me an example, where a woman comes to see you, and what you might find, and how you would handle the case.

B: Obviously there is a huge range of things I do, depending upon the stage of the cancer and the Western treatment be used, but I will give you a sense of how I work.

My greatest preference is to see someone before they have had surgery. I like to be able to take their case, and do the pulse, tongue and abdominal palpation in order to diagnose the underlying causes of their breast cancer. However, most people see me after surgery, but before chemotherapy. I make a point of getting breast cancer patients into my schedule to accommodate this. The difference between seeing someone before they have had chemotherapy and even after one treatment, can be enormous. Once the injury has begun, you can’t play catch-up because they continue to receive more toxic drugs.

In order to help protect their individual constitutions, I try to anticipate where the damage to the body may occur. I found that many women who had nausea during pregnancy, will suffer from nausea during chemotherapy. I ask if they have ever been anemic or short of breath. I ask them for past subtle symptoms. Often, those real key notes. I also ask them if they ever get mouth sores, such as canker or cold sores.

M: Would that indicate that their immune system is low?

B: Not necessarily. It indicates to me that they are prone to month sores and stomach yin deficiency from some of these drugs that are hot and toxic. People who get nausea and vomiting are more injured by the damp heat properties, and get chi reversal vomiting.

M: How would you proceed from there?

B: If a women is not receiving any additional therapy to the surgery, I proceed with treating the underlying imbalances. If they are going to receive chemotherapy, then my emphasis is still to treat the apparent stagnations (which are aggravated by the chemotherapy.) But I also try to anticipate the particular weaknesses that the woman is manifesting.

Treatment depends upon the individual. That is where the art of medicine comes in to play. The treatment is based upon their particular confirmation. I use a lot of abdominal diagnosis. Many women with breast cancer have been shown statistically to have ongoing problems with constipation. Even if a woman is having bowel movements, she may still be constipated. You can easily feel it with abdominal diagnosis. I think that this is a very important area to work with, because in alot of other natural medicine systems, one of the main treatments is bowel cleansing.

M: Is that true in Chinese Medicine, do they do cleansing?

B: Well, it is not called that, but it is done. Many herbs activate and remove stasis, or clear toxic heat by purging or activating the chi. Your body will naturally cleanse with the proper herb formula.

M: Do you think it is important to keep up the white blood counts?

B: Yes. When someone elects to have “heroic” medicine, such as chemo, you want the treatment to happen fully, and in the proper time frame. Supporting the bone marrow helps patients complete their therapy.

M: What about acupuncture?

B: I think that acupuncture is invaluable. I use alot of Eight Extra Meridian treatment to vitalize the organ chi. I also recommend doing a treatment that includes P6, no more than 24 hours before their chemo treatment. I have a very gentle needling technique, so people look forward to having their treatments.

M: How long do you treat a person?
B: Again, that depends upon the person. I tell people that this is not a little thing. Something has created this cellular change, and usually it is some deep level of stagnation. I don’t think that this is short-term care. Some people just want support during chemo, and I am willing to do that. But I let them know that I don’t feel their care is complete.

M: What do you recommend nutritionally?

B: `Recently a new patient chuckled as I described how to make bone marrow soup, because the other women in her group warned her I would be prescribing this. People on radiation are prescribed a miso soup that was used extensively in Japan to counteract the poison of radiation. During chemo, I actually encourage the use of red meat to help support the blood counts. I encourage people to eat organic and minimally processed foods, but mostly I encourage people to eat.

After chemo, I really want people to eat a clean diet. I ask people to keep a diet diary, and based upon what they eat, I will modify it. I like to tell people what to eat, such as lots of veggies, grains and legumes, rather than making them feel too restricted. I want people to eat well over the long haul. I recommend a lowfat diet with some animal foods. Dairy food is a no no. What you find in dairy food, because of the high fat content, is a high density of chemicals and hormones. Our bodies will tend to concentrate them in our fat cells, including breast tissue. Even the low fat dairy food tends to be phlegm producing.

Some people are drawn to a macrobiotic diet, some to ayurvedic, some to a naturopathic cleansing diet. In those cases, I will send someone to an experienced professional in those areas, to get further dietary counseling.

M: What role do hormones in meats and birth control pills play in the development of cancer?

B: First of all, they put an increased burden on the liver, since it is the role of the liver to break down estrogens. I think that estrogen causes blood stagnation. When you palpate the abdomens of women on Hormone Replacement Therapy you will find signs of blood stasis in the lower jiao. Someone using hormones really needs to have activating liver chi and blood moving herbs.

Another interesting point about hormones, is that several types of pesticides including DDT have an estrogen like effect in the body. Many of the women I work with remember chasing after the trucks spraying with DDT to kill mosquitoes.

M: Do you work with people emotionally during their treatment? Could you give us some examples?

B: Absolutely. I don’t try to be a psychotherapist, but I am very aware of the road these women walk down.

First of all, I try to create a safe, loving and nurturing environment where people feel free to tell me their story. I let them know, before their first chemo treatment, that it is common to feel anxious and scared. I let people know that depression and lack of mental clarity are side effects of the drugs. In a sense, I walk along, warning people of the emotional pitfalls that I see women fall in again and again.

Interestingly enough, one of the most difficult times emotionally is when the Western treatment ends. It is easy to feel vulnerable and frightened, where every ache and pain means a return of the cancer. I try to be supportive, but I also encourage people to get whatever Western tests that will alleviate their anxiety.

I also encourage people to become part of a support group. A study showed that women in a support group lived longer than women who weren’t in one. In terms of Chinese Medicine, this makes total sense. We need to relieve the liver chi stasis on all levels.

M: Could you briefly talk about your experience working with oncologists? Do you have friendly relationships? Can you talk to them about what you are doing? Are they interested?

B: I would say that oncologists in Boulder have been supportive of women doing Chinese Medicine if they want to. I wouldn’t say they are encouraging or discouraging people to do this. I respect that and I appreciate that. They are scientists. Oncologist want clinical studies proving that something works. And that is important to them and that is the way that their brains work. I respect that. Chinese medicine has hundreds of years of clinical experience and formulas that have been used for a long time but we can’t give them the hard scientific data that they are looking for. Perhaps some of the current research being done through the NIH Alternative Medicine Office will provide some more hard data to prove what 3,000 years of experience has shown. But in the meantime, oncologists can see the clients benefiting from it, enjoying it, appreciating it. And they respect that.

M: What advice would you give to an acupuncturist who has someone come to them with cancer?

B: As one of my teachers used to say, “study hard.” Learn everything you can about that cancer and it’s treatment. I personally feel strongly that it is important to learn the Western pathology and treatment, as well as the Chinese. I would also recommend working with practitioners who have worked extensively with cancer. Simply having only an intellectual understanding is only the beginning. You need to be familiar with the pulse, tongue and abdominal changes that occur during the course of treatment. I also recommend refining some the subtle diagnostic tools such as reading someone’s Shen and observing the face and back.

When working with someone with a potentially fatal illness, it is important to examine our own fears around cancer. People welcome frank discussions about their illness. At one point while I was treating people, I found a lump in my breast, and the fear and mortality became very real to me.

Working with these people has been a gift for me. I have the opportunity to support people during an extremely difficult time in their lives. Many times our conversations reach into deep levels and we both come out inspired and reaffirmed.

Thank you, Molly, for your interest and persistence in getting me to discuss my work. Obviously I have barely touched on a huge topic, but I appreciate the opportunity to share a little of what I have learned.