It's hard to believe that the trimester is more than half over
already. Once you are in the last phase of this program, the time
really flies. All your professors keep telling you that you need to
be prepared for graduation early because even though you don't have
class work to do you are still very busy. Busy with boards, busy
with electives, busy with numbers, busy with things outside of
school, and busy with planning what you will be doing
The patient load at clinic has been steady to busy most days.
This is great for all of us interns because we are getting more
experience and a good variety of patients. Also, there are little
to no worries about finishing our numbers for graduation on time,
which is a big relief. Being in a group setting with multiple
interns and a clinician to bounce treatments off and get second
opinions is great. It also has shown to be beneficial in that
everyone has a particular treatment or therapy they are very
proficient at. So we are all able to teach and help each other out
when it comes to treatment plans and patient care. This makes for a
very pleasant working environment at the NUHS Chicago clinic.
Treatment Room at the NUHS Whole Health Center
The past few weeks in my acupuncture elective course we have
learned the lung, large intestine, and part of the bladder
meridians. In Traditional Chinese Medicine, a meridian is the
belief about a path through which the life-energy "qi" flows.
Through needling these points, you are able to either tonify or
sedate the balance of qi in the meridian. The lung meridian
can be used for conditions such as cough, chest or shoulder pain,
asthma, shortness of breath, palpitations, fever, and many more.
The large intestine meridian is useful for symptoms such as
bloating, swelling, constipation, emotional stopping-up, headaches,
stuffy nose, or musculoskeletal pain. Finally, we learned a point
on the bladder channel called BL 13, which is useful for colds,
fever, cough, or flu-like symptoms.
The rest of my downtime has been dedicated to preparation for
Part IV board exams, which are the second weekend in November. With
Part I, II, III, and Physiotherapy now behind me, I am feeling much
more confidant going into Part IV. Part IV exams focus mainly on
skills learned throughout our chiropractic education including:
radiology, physical exam, patient intake, and chiropractic
manipulation. More details to come post-exams.
This week in clinic, I helped with a patient with a very
interesting presentation. The patient came in complaining of low
back pain that radiated down her leg all the way to her feet. Any
transitional movements increased the pain. The pain was described
as sharp and stabbing with numbness and tingling in her feet.
Bending forward or activities like coughing or sneezing would also
increase the symptoms.
All of these symptoms are a classic presentation of patient with
intervertebral disc problems. Therefore, our treatment began with a
McKenzie low back evaluation, which showed that extension would
help the patient. So, we started the patient with repeated, supine
back press-ups, which went well the first time. During the second
set of the exercises, the pain became very severe again and could
not be completed. From this point forward, we decided that pure
distraction (without flexion or extension) of the lumbar spine and
cold packs would be the best option while the patient was so
By the end of the treatment, we were able to get the pain down
significantly, but transitional movements still aggravated the
symptoms. So, we had the patient come in the next day so we could
continue treatment. The patient stated that the pain had decreased
significantly, and that there were no longer numbness and tingling
in the feet. That day we continued with the lumbar distraction and
cold packs, since the patient was still very acute. By the end of
the second treatment, we had the patient's pain down significantly
with no more radiation into the legs.
Saturday evening, Rob and I threw our Halloween Noir party. All
the guests were supposed to wear black and enjoy spooky music,
food, and drinks. Several of my fellow ninth trimester interns were
able to join in the fun including: Candace Gesicki, RJ Burr,
Jerrica Sweetnich, Ryan Meehan, and Bryan Robinett (all shown in
End of Week High
The week ended on a very high note. Exam scores were finally
posted for the September boards. I passed Part II, III, and
Physiotherapy Board Exams!! It's a very great feeling to have that
behind me. Now I only have Part IV to take in November, and then I
am finished with exams.
At the beginning of the clinic week, I presented my Journal Club
article. The point of the Journal Club is to have the interns bring
articles on treatment options for patients and discuss whether or
not we would use them with our patients.
My article was on the use of acupuncture for patients with
migraine headaches. The conclusion of the article was that
acupuncture does show a decrease in the number of days with a
migraine, and a decrease in the patient's quality of life. After I
finished with my presentation, we were all able to discuss our
opinions. We also talked about what other treatment options we
would use with a patient experiencing migraine headaches. My
current treatment plan for patients with migraines, which can be
changed per patient, includes acupuncture, chiropractic
manipulative therapy, post-isometric relaxation of the
sub-occipital muscles, and supplementation of magnesium,
riboflavin, and CoQ10.
Throughout the rest of the week, I finished my decorating for
Halloween, which is quite extensive. If you haven't noticed yet,
it's my very favorite time of the year. This included any final
touches, putting up the remainder of the decorations, more spider
webbing, and hanging my newest decoration. Every year the day after
Halloween, I check out the sales on decorations, and I buy one big
decoration to add to my collection. The decoration I added last
year was a five-foot tall hanging ghoul that I placed on my
balcony. It looks great out there, and I can't wait for people to
see it next weekend!
My newest Halloween decoration
On Sunday, Dr. Miller, several ninth and tenth trimester
interns, and I volunteered at the Bank of America Chicago Marathon.
It was the perfect fall day for the race with temperatures in the
mid-60s, which was ideal for the runners. Marathon Day in Chicago
is always a fun day because so many people come out to watch,
support, and cheer on the runners. Talking with some of the
experienced marathoners after the race, they said it's almost
impossible to get tired during the Chicago Marathon due to the
amazing crowds that come out to cheer them along.
Jeff Jones, Candace Gesicki, and me at the Chicago
Marathon on Sunday
We were in the Chicago Diabetes Project tent where we were
available for post-race care for the runners. The majority of the
runners were in a lot of pain and had very tight muscles, so we
helped by stretching and massaging as needed. I have volunteered at
the marathon before, but I haven't had as much one-on-one post-race
care. It was crazy to see how much pain some people were in, while
others looked like they could run the marathon again. I'm sure that
has a lot to do with training and experience with running. Overall,
it was a great experience, and as always it is so inspiring
watching people finish something as impressive as a marathon!
October 1, 2013, was the start of open enrollment for affordable
care act at healthcare.gov. So during my down time early in
the week, I made it a point to look at the site, and get acquainted
with it just in case any patients had questions. The site is very
easy to use with the initial process involving a few pages of
information to fill out to set up an account. You can also select
the state you are in to get information about that state's health
insurance marketplace or to be sent directly to that site to apply.
The site has been running a little slow due to large amounts of
people using it, but overall it's very simple to use.
The clinic time this week flew by. We had a very busy week at
the Chicago clinic with a high volume of patients and X-rays to be
taken. Having a large number of patients is great for me as a ninth
trimester intern because as soon as the tenth trimester students
finish with their numbers for graduation, those patients are turned
over to us. That process has already begun since several of the
tenth trimester students already have some of the numbers
Even though we do not have a large amount of our own patients,
we ninth trimester interns still have plenty to do to keep busy.
Each week we are assigned to a particular tenth trimester intern
whom we help with patient care and charting. Also, any of the X-ray
patients that come in are mainly our responsibility. Any other down
time we have is dedicated to file audits, OAPs that need to
written, and research to help with patient care.
On Sunday evening, Rob and I made Halloween cutout cookies, one
of my favorite Halloween traditions, for a party we are having in a
few weeks. Every year I forget how long the cookie making process
actually takes between making the dough, rolling out the dough,
cutting out the shapes, baking, frosting, decorating, and cleanup
afterward. But it is all worth it when they are finished because
they taste and look great! Plus, throughout the baking process, we
watch one of the best horror movies, "Halloween," and listen to my
favorite Halloween themed music. If you haven't noticed yet, I'm a
bit of a Halloween fanatic. Next week, I'll be sure to include some
pictures of my decorations.
Every other week on Tuesday mornings during ninth trimester, I
have a class called Journal Club. The objectives of the course are
to sharpen the student's research knowledge and evidence-based
practice skills. The final project for the class consists of
performing a literature search and finding a paper on a topic of
interest to us. We then need to put together a presentation on the
research article and share the information with the other interns
in the Journal Club.
I performed my literature search on the topic of acupuncture and
migraine prophylaxis. The article I found was a
randomized-controlled trial in which almost 500 patients were
randomly assigned to one of four groups. The first three groups
were three different acupuncture protocols, and the fourth group
was sham (control) acupuncture. Sham acupuncture means that
traditional acupuncture meridian points were not used in the
treatment. All four groups received the same amount of treatment,
electrical stimulation, and follow-up care. The primary outcomes
included the migraine frequency, migraine intensity, and migraine
specific quality of life surveys.
The results of the clinical trial showed that the patients in
the acupuncture groups reported fewer days with a migraine compared
to the control group. There was no difference in number of days
between the three acupuncture groups. The conclusion of the paper
was that acupuncture has a prophylactic effect for migraine
headaches. It also suggested that further research into the topic
is needed. The study was limited by short follow-up periods, the
physicians were not blinded, and a small number of acupuncture
points were used.
NUHS Whole Health Center - Chicago
Clinic has been getting progressively busier week by week. The
Saturday morning shifts are especially busy. It's a great day for a
clinic to be open since some patients can't make certain hours
during the week. This last Saturday in particular, I saw seven
patients during my six-hour shift. That isn't too large of a
patient load for a regular practice, but it is in a teaching
facility. In a teaching facility, you need to check in with your
clinician throughout the patient visit, and there is a large amount
of paper work to do. The reason there is a lot of paperwork is that
the clinicians want us to be comfortable with multiple types of
forms and paperwork so that when we are out on our own we are
comfortable with charting.
• First Patients and Jurisprudence Class
• Ideas for the Future
• Part IV Board Exams
To read older blog posts, scroll to the bottom and click the "Older Posts" button.