Acuhealer

Colds, Flu, and Kids

noreply@blogger.com (acupuncturenwpdx) — Wed, 04 Mar 2009 02:16:00 +0000

With this year's cold and flu season upon us, I am noticing the massive amount of kids coming down with runny noses, sore throats, coughs. although every kid seems susitible, some get hit harder than others. While this exposure to bacteria is important, and allows kids to build up their library of antibodies, there is lots we can do to build up their immune systems, so it can do it's job of fighting infections quickly, efficiently, and effectively. When kids are hit by one bug, and it knocks them down it can be hard for them to come back to their full strength before another exposure comes along. With just a little bit of support, kids can begin the season ahead of the game, or regain their strength, so they don't have to spend November to March with a runny nose.There are many tools and tricks you can implement at home to help reinforce the immune system. Making sure that kids have a well-balanced and varied diet can sometimes be a challenge. Working toward a diet full of whole foods will definitely help give kids a leg up with immunity. In addition though, because we can't always sneak in enough fruits and veggies, there are things we can do to supplement their diet and ramp up the immune system. Sleep is also another extremely important factor in immunity. Most 3-6 year olds still need 11-12 hours of sleep a day. Take advantage of the early sunset and try enforcing an early bedtime.
Another tool to try for your child is acupuncture and Chinese medicine. Acupuncture and/or acupressure can be extremely helpful to your child to fight off infection, both during a cold or sickness and as preventative medicine. Similar to allopathic medicine, in Chinese medicine we look at the common cold as an invasion of a pathogen into the Lung. We view this pathogen as a type of wind. Through a series of questions and inspection of the child, we use to determine if it is a wind-cold or a wind-heat, or in summertime, summer-heat with dampness. Wind-cold is classified by low fever with chills and lots of white thin phlegm; whereas wind-heat usually is exhibited through sore throat, yellow thick phlegm, and high fever with mild chills. Often, a kid will be prone to one or the other, and you might notice that your child's symptoms when she gets sick often look the same. We then chose acupuncture points which will expel the wind-cold or wind-heat and well as supplementing and boosting "wei" or defensive qi, otherwise know as the immune system. To read more about this syndrome you can visit: http://acupuncture.com/conditions/commoncold.htm.
In my practice, I tend to use a combination of acupressure and acupuncture with most kids. We always start with the pressure, just pressing the points, and then I gauge the child's comfort level. Most kids will allow me, even in that first session, to do at least one or two needles. I always make sure the kids feel very comfortable and they know that I would never sneak up on them. They are so relieved after the first needle, realizing they don't even feel it, and so proud of their bravery. And the results continue to amaze me. Kids are so quick to respond, and usually their coughs and runny noses taper off and quickly go away. Often parents will come back saying that their little one's cough stopped in the car and didn't come back, or that everyone has been sick at their school, but not their child! And the best is that the kids feel the results, they feel better and then are even more willing to be brave for more needles. It is so neat to watch them come back, excited to report their results and ready to feel better!

Acid Reflux and Children

noreply@blogger.com (acupuncturenwpdx) — Wed, 04 Mar 2009 02:14:00 +0000

Lately it seems that I've been seeing many kids with symptoms of acid reflux, acid regurgitation, and GERD. Depending on the age of the child, it can be hard to determine what's going on, but usually a child suffering from acid reflux will exhibit some combination of burping or vomiting, and/or the more difficult to detect and decipher nausea, stomach pain and burning. The child could also be coughing, having trouble swallowing, a hoarse voice, complaining of a sore throat especially in the morning, or respiratory symptoms, all can be possible symptoms of acid regurgitation. Acid indigestion has a number of causes. As a parent, sometimes you can identify a specific food that your child is sensitive or allergic to that is causing the response. Sometimes, the symptoms will be consistently occurring at the same time everyday, despite the changes in diet, possibly indicating an over or under production of stomach acid, or a malfunction of the lower esophageal sphincter, causing acid to leak back into the esophagus. Or sometimes (every parent's favorite) there will be no rhyme or reason, just an acid stomach causing pain, indigestion, burping, nausea, and/or vomiting.
Chinese medicine looks at acid reflux as either an excess or a deficiency in the child's system, or a combination of both. Kids are hot by nature. They have dominate yang. By nature their yin is not fully formed. Yin is everything cooling, descending, still, dark, and inward. As kids develop, their yin develops. They are starting off with a tendency towards heat and at a deficiency with their yin, giving them hot bodies that are not able to cool down as readily. Add to this hot nature, an imbalance, such as exposure to an allergen or a cold or flu, and their bodies can be set off with an over production of heat. It can be in their stomach and it will come out as acid reflux, or in their heart (Chinese energetic heart) and you see nightmares or ADHD, or in the lungs and the manifestation will be allergies or asthma. It is my job diagnosis and clear the heat and support their yin, through acupuncture, acupressure and Chinese herbal medicine. Often with this heat in the stomach, it just takes some redirecting, or descending of their energy, to help their digestion flow in the right way.
Every parents next question is "How will you get my child to sit still for acupuncture??" I've found that the most important thing is allowing the child to be in control. In my practice, I tend to use a combination of acupressure and acupuncture with most kids. We always start with the pressure, just pressing the points, and then I gauge the child's comfort level. It often helps the child to bring a beloved stuffed animal that we can "practice" on first. I can put needles in the animal, which provides a good test subject, and even let them help me, so, again, they can feel in control. After practicing on Teddy, most kids will allow me, even in that first session, to do at least one or two needles. I always make sure the kids feel very comfortable, and again, they know I won't sneak up or surprise them. Usually I just talk with them about their favorite game, or we sing a song together, or we count to ten or twenty while they sit with the needles, and then the needles come out. Kids don't need near the retention time/relaxation time with the needles that adults need, their bodies just take a little bit of redirecting to get back into balance. The results continue to amaze me. Kids are so quick to respond, and usually their symptoms are greatly diminished after that first treatment. Kids end up looking forward to their appointments!!

Digestion

noreply@blogger.com (acupuncturenwpdx) — Wed, 04 Mar 2009 02:02:00 +0000

Many people seek acupuncture treatments for poor digestion. They have been to see their doctor or a GI Specialist, which is exactly what you are supposed to do. We like to rule things out and make sure there is nothing more serious going on, the more information and people assessing a patient the better! But often times, when all of that is said and done, so many patients are diagnosed with IBS, which is basically a umbrella diagnosis for digestive upset. Many patients are left with very little explanation as to why their digestion is not 100%, and perhaps a prescription that they do not want to take.There are many different symptoms associated with poor digestion. From Constipation, to loose stools, gas and bloating, pain, acid reflux, fatigue after eating. Any of these sound familiar? What causes these symptoms? That is where Chinese medicine comes in. Our job as practitioners is to get to the root of the problem. We play detective and figure out how your body is out of balance. Chinese medicine is a system that works to figure out how your constitution is off and then we create a plan to regain balance. The healing happens through acupuncture, herbs, and possibly supplements. Many patients just get acupuncture treatments and get a lot better. We also think about food allergies. We might consider the elimination diet (http://www.everydiet.org/diet/elimination-diet) (the link is just an example, we would give you our clinic guidelines and walk you through the whole thing) We also might refer you across the hall to Doctor Levine (http://docerenaturopathicwellness.com/) for a food allergy test. When we know what a patient is allergic to we can treat the allergy with NAET (http://www.naet.com/) to completely eliminate the allergy!Stress can be another huge contributing factor in digestion. The most common diagnosis in US is, liver overacting spleen. Which basically means that your stress level is causing your digestion to be weak and vulnerable and manifest symptoms. The good news is we can treat it! Very effectively. Patients get great results. There are so many ways to address your digestion and if any of this sounds like you, we should. Poor digestion is something that you can live with but have too!

Trigger points

noreply@blogger.com (acupuncturenwpdx) — Tue, 02 Sep 2008 02:07:00 +0000

I find myself practicing a lot of trigger point therapy these days. I hadn’t planned on specializing in this area, mind you, hadn’t planned on focusing on pain therapy in general, as far as that goes, but the results of TPT can be so dramatic and so immediate that I’m mighty glad I have it in my arsenal.

What they are

For a variety of reasons – trauma, overuse, strain, stress, and god-knows-what – muscles and their connective sheaths (called fascia) can develop localized tender-to-the-touch knots. Interestingly, and one of the challenges for diagnosis, this pain can be referred pain – i.e. show up in an area away from the site of palpitation. Sometimes trigger points announce themselves clearly and sometimes they play ventriloquist.

Treatment

After consulting with a patient and deciding that a trigger point treatment is what they need and the pain is indeed coming from a tight muscle, we get to work. Unlike most other kinds of acupuncture treatment, where patients may not even sense the presence of the needles, a direct an aggressive stimulation of the trigger point is called for. The goal is to get the muscle to twitch. Once I see this happening, I know I’m on target. If it’s a new patient I definitely go easy. After all, it may be the first time they’ve had acupuncture.

Patient responses

Here are some comments the treatment has elicited: "I have been waiting my whole life for that," "it is like you are scratching my muscle right where it needs it" and "that feels so weird". (OK, so the last one doesn’t come across so well out of context. But I guarantee he was smiling at the time.)

Patients look forward to trigger point treatments, and some experience such relief they beg me to release more muscles.

My thoughts

I think of TPT as restarting the muscle’s metabolism, reminding it how to function normally. It seems the most common places to hold stress in the body are the neck and shoulders, lower back and hips, and the stomach. No TPT for the stomach, though. But don’t worry. If that’s where the problem lies, we have other therapies to bring to bear. Maybe that’s a topic for next time.

Acknowledgments

I want to thank Matt Callison (at the AcuSport Health Center in San Diego) and William Duarte (OCOM here in Portland) for getting me started on this path.

PS

Western medicine treats myofascial pain with trigger points of its own, and pain specialist Dr. Peter Dorsher of the Mayo Clinic published an interesting article earlier this year comparing them with those of acupuncture.

Another case of East meets West.

The Olympic Games

noreply@blogger.com (acupuncturenwpdx) — Fri, 01 Aug 2008 16:13:00 +0000

I had hoped that the news coverage of this year’s Olympic Games in Beijing would yield some insightful stories about health, athletes, and Traditional Chinese Medicine. Unfortunately, a man with 205 needles in his head, each with a flag representing an attending nation, isn’t what I had in mind. Groan.

Beijing and health

The news out of Beijing is dominated by concern over the high levels of air pollution. And even though the Chinese government is desperate to do something about it, there is widespread fear that Beijing’s air will be so bad that it will imperil both athletes and spectators. What a mess.

Asthma

The athletes most likely to be affected by air pollution are those who have asthma. And among those with asthma, the ones most at risk are long-distance competitors. So imagine the plight of Paula Radcliffe, the world record-holder for the marathon, who just happens to have asthma. I don’t know if the Chinese hosts will offer acupuncture to the athletes, but if she were my patient I would first determine if her breathing problems were tied to kidney or lung deficiency and then try to fortify her body in a way that would lessen the impact of pollutants. But the exact treatment would depend on knowing a lot more than I know now, so all I can say here is that I wish her well and hope the dietary regime she has adopted will help.

Exercise-induced asthma

Breathing problems can be brought on by exercise, even for athletes not diagnosed with asthma. Changes in humidity and temperature – as happens when aerobic exercise leads to breathing through the mouth -- can trigger EIA. And one would have to assume that irritants in the air would make things worse. I just hope that the athletes have been taking good care of themselves for the past year to ensure their bodies are ready for what they are about to be up against.

The Games

OK, let the Games begin, along with the hourly updates on the quality of the air.

And maybe, just maybe, a glimpse of how Chinese medicine is being brought to bear on the health challenges in Beijing.

On vacation!

noreply@blogger.com (acupuncturenwpdx) — Wed, 02 Jul 2008 04:12:00 +0000

Oh my gosh, where does the time go? After an invigorating and exciting beginning of 2008, July has arrived! And I'm ready for some relaxing and goofing around time with my family. For the next few weeks I'll be a slacker. Well, as much of a slacker as one can be with a family that includes a one-year-old. But that one-year-old needs time to connect with more than one generation of family, so here we come! I'll be back soon.

As Garrison Keillor puts it, Be well, do good work, and stay in touch.

Emily & kids

noreply@blogger.com (acupuncturenwpdx) — Mon, 02 Jun 2008 15:48:00 +0000

Acupuncture Northwest hires another acupuncturist! I am so lucky to be welcoming Emily Cohen, LAc, to the practice -- the same woman who has been giving me weekly acupuncture treatments. She is incredibly talented and while she and I practice a very similar style of acupuncture, she also brings an added passion for pediatrics. How lucky is that? She is great with all ages but has a special way with the wee ones. She has experience with ADD, ADHD, autism, allergies ( NAET has yielded great results), rashes, and much more. Kids get better so fast it’s amazing. I guess their little bodies are so close to perfect it usually just takes a little tweaking.

Of course the first question everyone asks is Do the kiddos get the needles? Well, we start everyone with acupressure at the beginning of a treatment and then, yes, surprisingly, perhaps, most kids are receptive to needling. We just figure out what is right for each patient. If we do needles it is for a very short time and the parent is usually right there reading a story or just being present..

At the end we let the kids sit down with markers and draw for a while or we tell stories or have them sing songs while we place seeds, with clear tape in their ears (it's called auricular therapy, and is a common practice in Chinese medicine). And sometimes we place a few on their body, too. We also at this point are giving the parents and kids a little homework -- massage ideas, specific pressure points, possible supplements, and lifestyle tips.

Kids really respond well to treatment. They love coming. They end up loving the whole process. They like to tell their friends and siblings that they get acupuncture and to show off their seeds. One even had his school picture taken while his seeds were clearly in evidence. That has to be a Portland first! Parents enjoy bringing their kids because they see the results, and they bring back great stories about their subsequent visits to their pediatrician.

Emily is a great addition to Acupuncture Northwest and we’re both looking forward to helping more and more kids.

Pregnancy

noreply@blogger.com (acupuncturenwpdx) — Fri, 02 May 2008 17:05:00 +0000

OK, this one’s for the women out there who are pregnant or considering becoming pregnant.

Choosing your health team

First, choose an OB who you are comfortable with – i.e you can talk with easily and who listens to what you say. There are many other things to consider, and good advice abounds on the web, so have a look around. WebMD and the March of Dimes are two sites that I recommend. And speaking of recommendations, a local OB that I highly respect is Lisa Johnson at the Women’s Clinic P. C. here in Portland.

Who else should you recruit for your support team? Every mother and every pregnancy is different, so there is no standard answer to this question. Some mothers enlist the help of a doula. Some a massage therapist. Some a midwife. Some an acupuncturist.

Acupuncture and my pregnancy

What does acupuncture have to offer? To start with, and speaking from personal experience, an acupuncture session can be about the most relaxing experience you can imagine. I looked forward to my regular appointments so much! Luckily, I didn’t have many specific symptoms that needed treatment, but the fatigue and stress of daily life are somehow intensified by pregnancy. Finding someone to help me with these was really important. Thanks, Emily; thanks, Brandon (now in Wisconsin – how is the badger state?).

My practice

In my practice I have treated patients for just about every pregnancy-related condition you can imagine, from morning sickness and lower back pain to nasal congestion and numbness in the hands (due to edema, temporary carpal tunnel syndrome can arise.) I recommend early treatment to help with nausea – the sooner it is treated, the better. And, I’ve found that although ginger is helpful for some, for others it makes nausea worse. So in addition to acupuncture, I find myself sharing from the cupboard of take-home tips.

When and how often should appointments be scheduled? This depends entirely on the individual patient. Some I see weekly from the very beginning, some only when a need arises. Like maybe sleeping isn’t as easy as it should be, or leg cramps are a problem, or it’s time for the 20-week ultrasound, or, well, whatever. I’ve treated mothers whose babies were in breech position (the best time to move the baby is 34-37 weeks), and when mothers have come full term, I have helped stimulate contractions. So I’m ready to help at any point, from conception to contraction, so to speak. I used to offer birth support, too, but with my own baby at home now, my schedule isn’t as flexible as it once was. All mothers will understand that!

An unexpected delight

At some point during treatment – I can’t say exactly when – I become aware of the baby as a person. I know all along that the intention of my treatment is to help the mother and the baby, but even so, there’s this moment when I sense the baby. Its pulse can sometimes be felt hovering around the mother’s. (In case you’re new to Chinese medicine, the pulse here is something more than you’re used to thinking of.) And right away I get this sense of connection with a new human being.

Now, I don’t consider myself an overly emotional person, but I have to say that when a mother first introduces me to her newborn baby, I am overpowered by a sense of . . . of what? Connection. Joy. Wonder. Motherhood.

Mind-body

noreply@blogger.com (acupuncturenwpdx) — Tue, 01 Apr 2008 17:24:00 +0000

When it comes to health and well-being, we all know that what goes on in the mind can influence what goes on in the body. Who could doubt, for example, that psychological stress can have a negative impact on one’s physiological function? Positive mind-body interplay can occur, too, and the simple act of anticipating good health can at times promote healing. The question is, at what times?

The therapeutic encounter

Surprisingly, one of the best known catalysts for promoting healing is the interaction that takes place between a healthcare professional and a patient. I’ve written about this healing alliance before, and even humbly suggested that this natural baseline healing process receive more attention in the world of medical research. So imagine my surprise when -- babba-bing, babba-boom -- I come across a book published this year that provides all of the scientific evidence one could hope for regarding the importance of the therapeutic encounter: The Placebo Response and the Power of Unconscious Healing, by Dr. Richard Kradin. He is an MD, psychoanalyst, and medical researcher. If anyone is going to probe the role of mind-body interactions in maintaining health, who better than a practicing MD who conducts research and is also a psychoanalyst who has co-directed a course at Harvard on Mind/Body Science?

The placebo response

Medical researchers have known about the placebo response for a long time and have been concerned with designing experiments that take this phenomenon into account when attempting to test for the effectiveness of new treatments. This natural tendency toward healing is a distraction, in a way, for researchers, and it must be tested for as rigorously as the effects of the main treatment.

But what is a distraction for some is the core issue for others, and Dr. Kradin systematically goes about demonstrating how the mind can bring about objective, measurable healing responses. People don’t just imagine that they are getting better, they really are getting better.

And he describes how the interaction of healthcare providers and patients is a crucial component of this response. So there you have it: the very act of seeking help from another can enhance acquiring that help. The origins of this response undoubtedly lie in our deep history as social animals, but I’ll leave that part of the story for Dr. Kradin to relate.

Parade Magazine

If you missed it in last month’s March 9 issue of Parade Magazine, here’s what many were reading over their Sunday a.m. coffee cups: Thoughts Can Heal Your Body, by Robert Moss.

PNAS

Placebo responses are commonly associated with the modulation of pain, and in the on-line June 26, 2007 issue of the Proceedings of the National Academy of Sciences is this article: Placebo effects on human u-opioid activity during pain. A pharmacologically inert cream was applied to the arms of healthy volunteer patients. In some instances the doctors told the patients that this cream would have no effect on pain. In others, they were told that the cream was a highly effective pain reliever. Same cream in both cases. No possible physical effects. Then a painful heat stimulus was applied, and the researchers measured the analgesic effect on their subjects. They also measured opioid activity in the brain.

And the results? Partly expected, partly wow. Expected: the placebo group reported perceiving less pain. But here's the amazing part: their brains were behaving differently. Several regions of their brains were responding by altering the pattern of their endogenous opioid activity. They were unconsciously creating a therapeutic effect. Wow.

Mind-body interactions. What will we learn next?

News, views & pets

noreply@blogger.com (acupuncturenwpdx) — Fri, 22 Feb 2008 00:08:00 +0000

Thinking about my profession and the public’s understanding of it, I became interested in how acupuncture is presented by the press. And what kinds of treatments catch the attention of health reporters. Treatments for fertility, particularly when used in conjunction with state-of-the-art Western procedures, seem to be the clear winners for shear numbers of reports. (Here’s another AP story on the subject to add to those I posted last month.)

Pets

Acupuncture for pets also catches the attention of news organizations. This recent article in the Oregonian tells the story of how an aging Labrador Retriever was successfully treated by Dr. Kelly Jenkins Nielsen. That’s right – Dr. Nielsen. After 20 years as an orthodox Western veterinarian, she decided to study acupuncture as an alternative treatment for the pets that came her way. Now it’s Dr. Nielsen, DVM LAc. (She is featured in an article in the Lake Oswego Review.)

Well, my sorta-half-Lab Otis is in good health and I have not yet entertained the idea of treating any non-human animal. But who knows? If he rolls in one more smelly thing, I may just start some sort of treatment program on him.

I had never heard of Buzzle.com before, but their news summaries include an article about how complementary modalities (acupuncture and chiropractics) have entered the world of veterinary medicine.

Humor

I don’t know why, but animal acupuncture seems to inspire a lot of humor. When browsing on-line organizations, for example, you find sites such as More Pets Get the Point, and the The “Paws-itive” Effects of Treatment. And some great cartoons are based on animals. My favorite has a woolly mammoth in it, and my vote for the animal most likely to show up in future cartoons is the species in this one.

The rest of the story

Although this article on the treatment of back pain is a notable exception, most acupuncture stories dealing with humans will not reach the threshold for being newsworthy. There’s nothing unexpected about that, I suppose. It’s probably the same for all healthcare providers -- the big story is preventive medicine. The big unwritten story, that is.

Seeking fertility

noreply@blogger.com (acupuncturenwpdx) — Fri, 01 Feb 2008 16:45:00 +0000

I love working with patients who are seeking help with fertility. Whether they are trying on their own for the first time or taking extra steps prescribed by their doctors (often IUI or IVF), acupuncture has the potential to help achieve conception. And there are few things more rewarding than helping couples realize their dream of having a child.

Happily, these days, when couples first begin considering what options exist for them, there is a good chance they have already heard something about acupuncture.

News coverage

Over the past few years, the news media have brought attention to the effectiveness of acupuncture. CBS, FOX, and BBC have each run stories about the successes of acupuncture and the results of fertility research programs. These stories highlight how the modern techniques of reproductive medicine can be enhanced by the ancient tradition of Chinese medicine. Enhancement isn't the whole story, however, and acupuncture can be of value to anyone seeking assistance. These latter people aren't so newsworthy, I guess.

More sources

WebMD and the American Pregnancy Association also have interesting information about fertility and acupuncture, and as I was browsing around the web for what fellow licensed practitioners are saying, I found this article in Acupuncture Magazine by Jennifer Dubowsky. My hat’s off to Jennifer for this article and her other insightful contributions on the subject of fertility.

Personal testimonies

There’s nothing like hearing from someone who has gone down the same road, and like many professionals’ web sites, mine has testimonials from some of my fertility patients |1|2|. But what can be more compelling than seeing and listening to real people? Like on YouTube: |1|2|.

Final thoughts

So there's a lot of information out there readily available for interested couples. It shouldn’t come as a surprise to anyone, I suppose, that the general health and well-being of a patient – something that is at the heart of Chinese medicine -- would have a direct impact on a patient’s fertility. Conception is a lot more than sperm meets egg. The physiological and emotional environments in which this takes place will have a dramatic impact on how events unfold. “Nourish the soil before planting the seed.” And then keep nourishing the soil through the ensuing pregnancy and birth. Then it's . . . slow drum roll in the background . . . parenthood. But that's a whole 'nother story.

"Aculand"

noreply@blogger.com (acupuncturenwpdx) — Tue, 01 Jan 2008 21:13:00 +0000

It’s often the case that immediately after an acupuncture treatment a patient will experience a kind of dreamy, euphoric state. When I was in school students and teachers would refer to the after-effects of acupuncture as “aculand." It’s not something any acupuncturist is attempting to achieve, it just seems to be one of the side effects of treatment.

My guess is it’s responsible for the items I often find left behind in my office or treatment room – checkbooks, sunglasses, watches. And it’s certainly on my mind when I schedule subsequent appointments. I always write them down on an appointment card and make sure they end up in a purse or pocket.

A research study of short term reactions to acupuncture

So imagine my surprise when I came across a research report on this very subject (“Short term reactions to acupuncture – a cross-sectional survey of patient reports” in Acupuncture in Medicine (2005, 23(3): 112-120 [abstract]). The authors don’t use the term “aculand.” Maybe it’s a term that’s not going to make it into the research vocabulary.

It’s a UK study with a sample size of 9408 patients! They were asked about their reactions during or immediately after treatment by practitioners of their choice (a total of 638 different acupuncturists).

The results

Well, I have to say, I was surprised at the frequency of responses. An amazing 95% of the patients reported experiencing at least one short-term reaction. The most common reaction? 79% reported feeling “relaxed.” Next, 33% felt “energized.” (This is more than 100% already because patients could report more than one response. The average number of responses was 1.8.) Next, 24% reported feeling “tired or drowsy.”

There were some responses on the “negative” side of the ledger, too. Which doesn’t surprise me. Temporary discomfort can be a part of healing. Some people get worse before they get better. It is totally normal for symptoms occasionally to flare up before they resolve. It’s my experience that if symptoms do get worse, they usually will last 24-48 hours and then improve.

And sometimes a small amount of pain is not really a negative thing. It can be the sensation of de qi, an integral component of acupuncture that is receiving its own research attention.

There was a very low response level for persistent “aggravation of symptoms” (1.8%). Interestingly, only 13 patients (an incredibly low 0.14%) responded that they were unwilling to have acupuncture again because of these “negative” reactions.

My new perspective

First of all, thanks to Hugh MacPherson and Kate Thomas for having conducted and published this study. It’s important to bring objective information to the table when talking about patient reactions to acupuncture. I was aware of the existence of short-term reactions, and my patients sometimes refer to them in their testimonials |1|2|, but this study alerts me to its nearly universal – and variable -- nature.

I’ll be watching my patients a little more closely. And maybe reducing the content of my lost and found drawer.

Golfer's yips

noreply@blogger.com (acupuncturenwpdx) — Sat, 01 Dec 2007 18:03:00 +0000

The case of the curious golf affliction – the “yips”

A lot of my patients come to me because of chronic pain. So it’s no surprise that I see a lot of athletes – bikers, runners, tennis players --seeking help in restoring their performance levels. However, nobody has come to me, yet, with the specific request that I help their golf game. I’ve helped some here and there, but it’s always been a secondary consequence of treatment (a couple examples: |1|2|).

Well, thanks to an article in the journal of the British Medical Acupuncture Society (BMAS), I’m now ready to be of more direct help. Seems there is a condition that uniquely attacks golfers – the oddly named “yips.” It’s not really painful. Unless you’re a golfer. Adding about five strokes per round can hurt a lot.

Little did I know that this condition has been the subject of intense research (cf. A Multidisciplinary Study of the ‘Yips’ Phenomenon in Golf, Sports Medicine, 2000, 30(6) 423-437, and The ‘Yips’ in Golf, Sports Medicine, 2003, 33(1) 13-31). And now, thanks to BMAS (and their generous presentation of many articles through their web site), a role for acupuncture is revealed: Acupuncture for Treatment of the Yips, a Case Report, by Palle Rosted (Acupuncture in Medicine, 2005, 23(4): 188-189).

What are the “yips”?

Many amateur golfers, and more than a small number of professional ones, lose control of the muscles in their arms in such a way that they can’t smoothly move a putter to and fro. Their arms can cramp or sometimes make involuntary movements. Aggravating if you’re an amateur, a catastrophe if you’re a professional.

A continuum of causes

The subtitle of the 2003 article in Sports Medicine is “A Continuum Between a Focal Dystonia and Choking.” It turns out that the yips are a psychoneuromuscular impediment. Yikes. Multiple causes here. From a localized neuromuscular problem to a psychosocial one – choking in common parlance.

The article on treating with acupuncture

Why do I like this article so much? First, it’s based on a sample size of one. That’s right, one golfer. One 65 year old Brit with a handicap of 14. Who would ever take seriously a study of sample size one? Well, me. If you read my blog on sample sizes in research and practice you’ll know why. Suffice it to say here that in an encounter between caregiver and patient, the sample size is always one. What I learn about one golfer today can help one golfer tomorrow.

Second, because it encompasses what acupuncture and Chinese medicine in general are so good at. The yips are a symptom. And we don’t attack symptoms willy-nilly. What is the cause of this symptom? Discovering this will take both rational evaluation and intuitive diagnosing. It takes listening. Same for the treatment. Rationality and intuition. Science and art. From sample sizes of N=1031 and N=72 describing the phenomenon in the two Sports Medicine articles, one golfer (N=1) gets treated in such a manner that he overcomes an impediment. I love it.

The cure for the N=1 golfer

Whatever physical muscular problems are involved with the yips, they are exacerbated by performance anxiety. The patient of this study did not clearly present physical or anxiety-related symptoms, so Rosted chose a combination of points to address the condition. (The details: GV20, EX-HN-1 [Si Shen Cong: four points one cun from GV20], and TE5.) The symptoms were gone after one treatment (a total of five were given), and there were no relapses by the 24-month follow-up.

Final thoughts

Performance anxiety and repetitive motor skills are important in lots of people’s lives. Maybe this isn’t so unique to golfers, after all. So, OK, I’m ready. Bring on the golfers, musicians, and poker players and let’s see what kinds of psychoneuromuscular impediments we can resolve. One at a time.

We're all N = 1

noreply@blogger.com (acupuncturenwpdx) — Thu, 01 Nov 2007 16:15:00 +0000

There is a ton of interesting acupuncture research being conducted these days, and there is no doubt that we all will benefit from this work, practitioners and patients alike. Our aims are the same – bringing about healing. As I’ve been thinking about the actual research itself, though, I’ve become aware of a kind of disconnect between medical researchers and the patients they recruit for their work. These researchers are most interested in “Does treatment/drug X have a measurable effect on symptom Y?” And as a matter of good research protocol, they have to remain as neutral as possible about the outcome. That is to say, they can’t bias their work by hoping for one result or another.

Double blind research protocol

More importantly, some sort of randomized trial has to be set up and a placebo chosen. In the case of acupuncture studies, some type of “sham acupuncture” is employed (either inserting needles at random points disregarding established meridians, or only pretending to insert needles). Controls such as these are needed to ascertain whether the main treatment variable is the one responsible for any positive effects that might ensue. And then, in an attempt to remove bias from the gathering of data, a double-blind situation is set up whereby neither the doctor nor the patient is aware of which group he/she is in. (A real hurdle, for obvious reasons – the acupuncturist knows what group the patient is in, but at least the recording of results can be performed by someone who is unaware of treatment group assignments.)

A conundrum – two different views of sample size

The medical researcher is interested in the statistical results of the test. Does the treatment group differ significantly from the placebo group(s)? Statistics are based on samples of patients, and the larger the sample, the better. Sample sizes are referred top as "N," so a sample size of 100 patients would be N = 100. The patients, on the other hand, are interested in their own personal health. Each is a sample of one. Hence the N = 1 in the title of this blog. How does the perspective of N = 1 relate to the perspective of the N = 100? Here's where it gets interesting.

Lots of studies have failed to establish a statistically significant difference between treatment and control groups. So the researchers must conclude that the treatment is not effective. But there may be many individual patients who experienced significant individual benefits! It’s just that the significant individual benefits in the treatment group did not exceed the benefits of the control group.

The researcher, in a sense, has to dismiss the treatment’s effectiveness as being no better than the placebo’s. But each patient that responded positively has to be delighted, right? Nobody ever claims that their symptoms were less severe or that their recovery was less real. From their perspective the treatment (even if it was the placebo, and I’ll have more to say about placebos in a later blog) was successful.

What this means to me as a practitioner

As I treat patients, I have to be aware of what research has revealed about the kind of medicine I practice, and it certainly informs my treatment options, but every patient I see is a sample size of one. And what that means is that I look for unique, individual avenues to explore, and these avenues are not constrained by statistical evidence. I find this liberating in a way because it allows me to be creative in my practice; but also because it reminds me that my goals and my patients’ are the same – healing. And it really doesn’t matter if the exact same treatment given to another patient would not have the same result.

Significant individual benefits are not dependent on statistical significance in a clinical setting. I’ll have to talk to my family doctor the next chance I get and see if she has come to this same conclusion.

Unexpected outcomes

noreply@blogger.com (acupuncturenwpdx) — Mon, 01 Oct 2007 21:10:00 +0000

Want to know one of my favorite things about being an acupuncturist? Watching people experience healing in unexpected ways. Someone comes in for shoulder pain, right? I treat her for a few weeks with LI 4, LI 11, TB 14, SI 10, TB 10, SI 11, and a few ashi points and her shoulder gets better. She's happy about this, obviously, but then as we're chatting about preventive care and other things, she says "Look at the nail on my index finger! It's finally better." This nail had been a nuisance to her for a long time because of a really gnarly crack right down the middle. Now it was growing normally. What a treat to share in her excitement. What a treat to watch people walk away with more healing than they had thought possible

And, of course, fellow professional acupuncturists will just nod their heads, because although the details of unexpected outcomes such as this can't be predicted beforehand, the occurrence is by no means a surprise. I never explicitly said this to her, but I wasn't directly treating her main symptom, shoulder pain. I was treating qi and blood stagnation in the TB, SI and LI channels for her shoulder but also liver qi stagnation, which is a common diagnosis and if treated properly will create a lot of change for the patient. Sometimes this is referred to as the root and the branch. The root cause is a fundamental imbalance that needs addressing, the branch is the specific symptom. If I am successful in resolving the root cause, the "main complaint," or branch, will respond. But removing the root cause unleashes the possibility of an effect on any number of symptoms for which the patient wasn't seeking treatment.

The phenomenon of fingernail healing

The patient's surprise became my surprise when I was reading an article by Daniel Schulman in The Journal of Alternative and Complementary Medicine (abstract; sorry, you'll have to go to the library to see the entire article). His article is titled The Unexpected Outcomes of Acupuncture: Case Reports in Support of Refocusing Research Designs. His main focus is on research (and I'll get back to that myself in a minute), and he describes two clinical cases of unexpected results. Guess what one of them is. You're right, a fingernail healed. This time, a thumbnail. A woman who had come in for treatment of acid reflux and headaches, among other things, never mentioned her thumbnail until one day she happily reported that this longstanding problem was gone.

Unexpected outcomes as a challenge in research methods

The existence of unexpected results such as these points to one of the difficulties that the scientific community is having in designing relevant tests - particularly when comparing the results of acupuncture to conventional biomedical treatments - for the effects of acupuncture. If either my patient or Daniel Schulman's had been in a clinical trial for effectiveness of acupuncture in the treatment of their "main complaint," would unexpected outcomes such as these even be documented? I haven't read a case in which they have. Even more of a puzzle presents itself if a clinical trial reveals no statistical difference between treatment and no-treatment for a symptom. What if my patient still experienced shoulder pain, but slept better, was happier in general, and experienced any number of other unexpected outcomes?

I'm not a scientist, but I'm aware that the so-called "gold standard" of clinical research, randomized, controlled trials (RCT's) have their inherent limitations and there are many challenges facing those in the research community who are interested in comparing different treatment modalities. I've just begun reading some of what Ted Kaptchuk has been writing about all of this (here's his amazing bibliography) and look forward to learning more.

Until then, what to make of this fingernail phenomenon? How common is it?

Healing alliances

noreply@blogger.com (acupuncturenwpdx) — Thu, 30 Aug 2007 20:25:00 +0000

How can I optimize the treatment of my patients? How can I provide the best healing experience possible? It begins with a partnership with each patient – a unique healing alliance. How does this alliance develop?

Listening

It begins with listening. Listening for a patient’s personal understanding of whatever symptoms brought him or her to me. Dealing with illness or pain can be as emotionally draining as it is physically trying. So I also ask about expectations and anxieties. I listen for small details that might convey meaning. It isn’t uncommon for a patient’s needs to be greater than what can be objectively diagnosed. How else to discover this than by listening?

What follows

The result is shared communication. Shared attention. Shared concern. And how could it stop there? Compassion follows automatically. As does a shared vision of what this person’s life would be like without whatever symptom has initiated this interaction.

This is what it means to say I strive to treat the person, rather than the symptom. This is certainly one of the things that drew me to Chinese medicine in the first place.

The unexpected power of the therapeutic alliance

What I now realize is that this interaction has healing power in and of itself. Progress on the road to healing can begin even before acupuncture, before herbs, or before any kind of treatment. Several clinical studies have demonstrated that there is therapeutic value to this healer-patient interaction. This is why randomized clinical trials are needed, after all. Researchers attempt to control for this phenomenon when testing the efficacy of a new drug or treatment. Otherwise, how would we know when a new treatment was effective beyond this important baseline?

All of this is true for Western medicine, too. There even have been instances in which once-orthodox drugs and treatments were abandoned later because subsequent controlled studies demonstrated that the main variable bringing about the positive outcome was the interaction with the doctor, not the treatment itself. Isn’t that amazing? It’s even true for some surgical procedures, believe it or not. Patients were experiencing healing for reasons other than the specifics of the operation. Doctor and patient expectations can have such dramatic effects on treatment outcomes.

A humble suggestion regarding medical research priorities

Dear mainstream and alternative medicine researchers, please focus more investigative energy on that part of your research that is normally referred to only by way of comparison with a main treatment group -- that phenomenal baseline of healing. Please discover more about how all practitioners can be better healers, regardless of the types of treatment involved. What mind-body phenomena are at work when patients and doctors interact, and how can we enhance these effects? What physiological interactions between the nervous, immune, and endocrine systems are taking place when a healer and a patient establish an alliance?

Until we’ve discovered more, I’ll keep listening for clues from my patients.

Road to Gotham

noreply@blogger.com (acupuncturenwpdx) — Wed, 01 Aug 2007 18:22:00 +0000

Starting this business has been one of the best experiences of my life. And whenever I’m in danger of losing sight of this, I pull out one of my business cards, put it on the table and have another look at it. And there it is, Sarah Hayes, LAc, Acupuncture Northwest, The Gotham Building, Suite 171, Portland, Oregon. Yes!

While I was on that long road from graduate school to practicing acupuncturist, I initially had only vague notions of how I was going to reach my professional goals. I had no idea how many business questions I would be asking, or how many people I would be relying on to help me know what questions I should ask. Three and a half years of medical training had me ready to treat patients, but the two business classes (two!) left me feeling like a babe in the woods.

Looking back, we were all so wrapped up with our studies that the business ahead of us was the last thing on our minds. We were focused on learning the medicine. If I thought about it at all, I thought I might join another practitioner, or maybe a group of alternative care practitioners, or maybe purchase an established practice. Like I say, it wasn’t exactly clear during my student days. In the end I decided the way I would ultimately be the happiest was on my own. I wanted to go it alone. Looking back, it was the right choice for me.

First questions

How much rent could I afford to pay? How much should I charge my patients? How many patients will I need in order to break even? What part of Portland would be best to locate in? Is off-street parking important? What should my business cards look like? How much do they cost? How else to advertise? Should I create a web site? What insurance companies should I contact for liability insurance? How do I become eligible to charge patients’ insurance companies? What kinds of treatments are covered by insurance companies? Who are the best medical suppliers? Should I build my own inventory of herbs? What software would be best for bookkeeping? On that glorious day when I have my own treatment room and a treatment table, should I use sheets or a paper roller to save on laundry?

Finding a business manager

So what I really needed was someone to put these questions in their proper order, tell me which ones to answer first. I remember thinking “Shoot, what I need is a business manager.” Followed by “Oh my gosh, that would be me.” I was about to become a business- managing/landlord-contacting/insurance-calling/bookkeeping/ laundering acupuncturist. Last thought that night before going to sleep: “Oh my god.”

A comparative study looking at CAM practitioners

How many times has this realization occurred to someone like me? Many, many times, as it turns out. The Sept-Oct, 2002, issue of the Journal of the American Board of Family Practice has this article in it: Characteristics of Licensed Acupuncturists, Chiropractors, Massage Therapists, and Naturopathic Physicians. The authors (Cherkin et al.) wanted to compare practitioners of the four main branches of complementary and alternative medicine (CAM) with conventional physicians. The result that caught my eye was that more than 60% of the acupuncturists in their survey practiced solo. This compares with about 25% for conventional physicians.

Also mentioned in this article is the fact that although there is increasing interest in and use of CAM, there is still a good deal of separation between differing healthcare services in general. CAM practitioners, when they do work in clinics, tend to associate with other CAM professionals, and likewise for conventional physicians. Acquiring integrated care, at least by this measure, is still largely the individual patient’s responsibility.

Feeling lucky

noreply@blogger.com (acupuncturenwpdx) — Fri, 29 Jun 2007 21:19:00 +0000

Why I feel lucky to be practicing Chinese medicine

Starting my business -- Acupuncture Northwest -- has been one of the best experiences of my life. I really think that I am in the right place at the right time, doing the right thing. Attitudes toward complementary medicine (CAM) have been changing dramatically over the past few years, and in addition to success stories such as Portland’s two colleges of Oriental medicine (Oregon College of Oriental Medicine and National College of Natural Medicine), Western doctors are increasingly recognizing the need for complementary therapies.

An interesting CAM study

Medical publications have quantified this trend in various ways. As an example, here is an abstract on the topic from the journal Pediatrician and Adolescent Medicine. Interestingly, studies such as this one often find that a large proportion of Western doctors are interested in learning more, and even being trained in, CAM.

An MD talks about CAM

James Rotchford has written a compelling article that is aimed at his MD colleagues searching for expanded treatment options for their patients. An excerpt (from Medical Acupuncture):

“. . . we uncommonly have the opportunity to see our patients feeling better when they leave our offices than when they arrived. However, patients who have received acupuncture often feel better and have objective signs of improvement even before leaving the office. In part it could be due to the endorphins that are released through acupuncture. Nonetheless, the sense of well being and the immediacy of effect are noteworthy and satisfying to see in patients who have received acupuncture.”

And continuing in his advice to Western doctors he relates:

“For me the medical history comes alive in new and exciting ways as a result of my studying oriental medicine and acupuncture. With oriental medicine not only what the patient tells you but the context in which they tell you is very important. If you enjoy literature or listening to a good story, I'm confident that you will experience a new satisfaction in taking a thorough medical history . . .”

All I can say to that is Amen, Brother. The more all health practitioners can know about context, the more we can really know the person we are treating, the better we are able to offer healing.

Maybe we’re all in the right place at the right time. Wouldn’t that be nice?

First blog

noreply@blogger.com (acupuncturenwpdx) — Thu, 31 May 2007 17:48:00 +0000

Hello. I’m Sarah Hayes, a licensed acupuncturist with a clinic in Portland, Oregon. And as of today, I’m also a blogger. My hope is to use these pages to join the community of healthcare givers who share their insights and experiences with anyone and everyone who is interested. If that doesn’t mean blogging, I don’t know what does.

My contribution to those interested readers out there? Well, I’ll be writing mostly about my patients, what it means to be a practitioner, and the interactions that have taken place between us. Because I practice Chinese medicine (I’m also a certified Chinese herbalist), there is this important aspect of interaction. Some, for example Ted Kaptchuk in The Web That Has No Weaver, refer to this interaction as a healing alliance. I like the term. (Ted Kaptchuk discusses more about Western and Eastern medicine in an interesting interview conducted by Scientific American Frontiers.)

So my focus will be on Chinese medicine, probably some expanding on the comparisons with Western medicine, what it’s like to be an acupuncturist, and what rewards and surprises I’ve found by following this path. Speaking of surprises, I’ll be including some of my experiences on the business side of things, too. What it was like to graduate and, gulp, step into the world of spreadsheets and laundry sheets. And medical suppliers and taxes. And just how does one go about getting patients to walk through the door, anyway? Why didn’t graduate school have a class in acubusiness? These were the things on my mind back when I first opened my clinic’s door in December ’05, and for the most part they’re still on my mind today. How much longer will I go on doing my own laundry?

I’ve done some looking around, but not nearly enough I fear, locating informative blogs on alternative medicine to share here. What I’ve got so far you can see in the sidebar. Since I’m new at this, and the volume of voices out there is daunting, any suggestions you have for locating relevant sites to check out would be much appreciated.

OK, I’m off and running. I’ll be posting here regularly for the foreseeable future. Wish me luck.