Archive for tag: clinic

What a Good Week!

Hello, prospective students! If you are new to my page you may not know that I will be graduating in August. Yay! 

About a month back I took the first of my four board exams. Some states only require three, so to see what your state requires you may go to nccaom.org and browse for state requirements. Usually when you take the computerized board exam it will tell you if you passed, but since the biomedical portion is so new they are still working out kinks so they mail the results. It's grueling because you have to wait 30 days. I received my results this week and I passed! It is such a good feeling to see the results. 

Besides my results, I had a good week in clinic. I had 16 patient visits to add to my tally sheet to meet my 450 total patient visits for all my clinic shifts. I saw my continuing patients but also a few new cases. I filled in for an intern who usually sees PTSD patients. These patients receive specific auricular points to help cope with their stress and anxiety. These patients are so grateful because they are experiencing results and receive the treatments for free.

Something Different

Dr. Yihyun Kwon has started to see stroke patients in the clinic. This is part of his ongoing stroke clinical study on the results of acupuncture and herbs in stroke victims with any kind of paralysis. I have been very lucky to be able to observe his cases as he takes a history, needles and gives the patients instructions on home exercises and dietary changes. Some of the points he uses are not commonly used in clinic, as well as his needling method, so it is fascinating!

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On Thursday I had the pleasure of eating with one of my favorite professors. She wanted to cook for a fellow acupuncture grad who has treated her in the past. It was her way of saying thank you to the grad and she invited me as well. We had a feast, as you can see in the pictures. We had noodles, fried rice, tofu, shrimp, fish, baby bok choy, dumplings, and egg drop soup. Oh my, it was so much food and so yummy! 

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Clinic Success

The weeks keep flying by, probably because I am in clinic six different shifts, which seems to make the days fly by. I would like to take a moment to talk a little about a special case I have. I started treating a patient this trimester that was recently diagnosed with fibromyalgia. 

Everyone is familiar with the word or diagnosis of fibromyalgia, but how is it defined? Fibromyalgia is defined as a disorder of the muscles and connective tissues. Patients have muscle pain, tender spots, and they may have sleep disturbances, fatigue or depression. Researchers have many theories of what may cause fibromyalgia such as low serotonin levels, or an increased chemical called "substance P" that can be caused both by stress or emotional trauma. Others believe muscle "microtrauma" leads to fibromyalgia, and yet some researchers believe genes play a role in how the body responds to pain stimuli. 

Diagnosis

In TCM, we diagnose based on the answers the patient states about their pain as well as their response to questions about other bodily functions. TCM does have acute and chronic pain diagnoses as well those that sound like they have nothing to do with pain. However, we always diagnose the whole person and not just their manifestations.  

Elizabeth -group _web 640Fellow interns.

Treatment

I started treating my patient at the beginning of May. Her rheumatologist had just diagnosed her as having fibromyalgia two weeks previously. During history taking, she said she also had severe arthritis in her toes and knees. These disorders were confirmed by either X-rays or bone scan. After completing an extensive history, I came up with a diagnosis with my clinician and began treatment. My point prescription was based on the pattern the patient had that seemed to be causing the TCM organ disturbances and thus the pain. After the treatment I discussed with the patient how often I would like to see her and when I would reassess the condition. I wanted to see her twice a week for three weeks.

Results

After the two weeks she seemed to be getting great results. Her pain went from a 5 on VAS pain scale to no pain but just soreness. She also had no headaches, an improved mood and some increase in energy. She has not had to take her Celebrex for pain control in two weeks.

Self Help

After such improvement, I wanted to incorporate stretches that she could perform at home to relax the muscles and tendons. I consulted some of my books but also my fellow chiropractic students. They gave me instructions on how to perform the stretch and how it would benefit the patient as well as the results I should see. After explaining and showing these stretches to my patient, I also gave her diagrams of the stretches with instructions of how many reps, sets and amount of time to hold.

She was very grateful and appreciated the time I took with her. This in turn made me feel good because that's what I look forward to every day--helping my patients improve their condition as well as allowing them to take control of their health.

Follow-Up

After reassessing her pain condition I have concluded that we can treat once a week and hopefully see enough improvement that we can do monthly treatments to keep her energy balanced.  

Clinic

This trimester has brought much change to the clinic environment. Most of the change is good and the rest just needs mending.

Previously, we saw three return patients a shift, with approximately an hour and 15 minutes for each patient. Currently, we have two shifts, one from 8 am to noon and the second from 1 p.m. to 5 p.m. That also may be changing with the addition of students to the clinic shifts. There has been talk of schedule changes this whole trimester but they finally have been implemented.  

The new schedule

The new schedule allots an hour for a return patient and an hour and a half for a "new" patient (previously two and a half hours). The "new" patient visit lasts longer because a full exam and history must be done. An exam includes blood pressure, pulse rate, respiration and temperature, and it can include orthopedic and neurological exams. A chiropractic intern joins us to ask any additional questions and provide a western diagnosis for insurance and charting purposes. In Illinois, acupuncturists cannot diagnose a patient with a disease. The new patient also receives acupuncture and herbs, if necessary. So with the new schedule, this is all done in an hour and a half, an hour shorter than the previous time schedule.

A positive is the student is faced with a realistic time slot for future practice arrangements. For me personally, I think it will be a big challenge to get a full history and exam with the allotted time, especially with all the discussion that is involved with the clinicians that also takes time. Another positive to the new schedule is that it will eventually allow the intern to see four patients a shift. This will add ease to those that are behind on their numbers to graduate.  

Another change

The other change is the individual evaluations given daily by the clinicians. Each intern will be evaluated by his/her clinician daily with a weekly prognosis sent by email. I appreciate this because the intern can see their growth through their time as an intern.  It can also be a good tool for the student to ask questions on how to improve if their comments did not meet their expectations.

Currently, the process is in a transition because each clinic shift receives a letter grade that reflects our number score of the average of the evaluations. We as a student body are requesting that this change to a pass or fail system, so as it will not affect our grade point average. This is important to those that rely on scholarships to help fund their schooling. It is hoped that with time everything will fall into place.

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Dr. Hyundo Kim is pictured above. He is my Monday clinician as well a previous professor. Dr. Kim provides us with much knowledge of differential diagnosis as well as how to create great herbal formulas.

Patient Visits

I feel like the weeks just fly by the more days I am in clinic. Patient visits are starting to pick up with the help of my wonderful husband referring his patients to me. Referral networks are great and definitely needed in practice. In clinic, we often see other students, but many of the students have issues that you will see in practice such as muscle injuries, stress, menstrual irregularities, and allergies. Acupuncture and herbs gets good results with the conditions listed.

The key to Chinese medicine is to find the right pattern and treat it appropriately. That is probably the hardest part. There are so many patterns or diagnoses that have to be ruled out. Often times, there are many layers to the patient's condition. Those layers play a part in the diagnoses. Diagnoses have two parts in Oriental Medicine, the root and the branch. For instance, the branch problem may be allergies, but once you ask all the 10 questions and take tongue and pulse, there may be other reasons or "roots" the allergies or "branch" is taking place.

If you are new to oriental medicine, we feel the pulse in three positions along the radial artery. This helps us decipher the Qi of the person, and depending on the position of the pulse, in what organ the Qi is having problems. The tongue is also examined and it gives us a picture of what is happening in the "organs" on a blood level. We look at the shape, color, coating, and the sublingual veins underneath the tongue. The pulse is quicker to change than the tongue so the pulse can more accurately tell us about the "branch" problem and the tongue can have a more accurate look into the "root" problem.

Doctor Visits

EyeFor instance, my husband's eye periodically gets red ever since he accidentally flicked something into his eye while he was in anatomy lab. In oriental medicine, a red eye that is painful can be diagnosed as Liver Fire, Liver Yang rising, Heart Fire, Kidney and Liver Yin deficiency with deficient heat, Lung heat or Phlegm heat, invasion of Wind heat, or damp heat in the Bladder. Unfortunately, other things can influence the diagnosis such as his lifestyle, the foods he eats, his constitution, and any other pathologies he might have. It is not an easy feat to diagnose.

However, this past week it has gotten very red and painful so we spent most of our Saturday at the doctor. He has seen five different ophthalmologists and numerous acupuncturists. The acupuncture does help with the pain but it can take many treatments to help the redness and inflammation. We are using acupuncture and herbs to treat him. This is better than the alternative of steroid injections into the eye. We are also going to get an inclusive allergy test done to check for any allergies that may be contributing to the problem.

Come and Gone

Wow, it's already the end of the first week of classes. Our summer break of two weeks has come and gone and I wish we still had two more weeks. This trimester I am light on classes with only four and three clinic shifts. I guess I am getting a reprieve from the seven classes I took last trimester.  However, I am using my time to refresh on older material and to really study herbs.

I am taking Herbal Treatment Strategy, Western Nutrition, Herbal Formulas 2, and Business. My three clinic shifts are supervised under Dr. Xie, Dr. Fan and Dr. Zhu and Jia. I was especially excited to be under the supervision of Jia because she is emphasizes the importance of palpation in treatment. But enough about school for now, I'll get back to that later.

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The Summer 2010 graduating class was our biggest so far. Four students graduated from the Acupuncture program and three students from the Oriental Medicine (or Herbs program as the students call it, which is acupuncture and herbs together). It was a bittersweet graduation because my good friend Nicole graduated. She is from Charlotte, North Carolina. She also graduated the chiropractic program with her husband in December and they are opening their own business in Charlotte. Not soon after break started, I helped her pack her belongings into her car so she could drive back home. As students, we learn from class and each other and Nicole has taught me many things. I plan to visit Nicole and Andy in North Carolina and I will update you on their practice.

The other "herbal" students that graduated also have big plans. Andrea has left for China. Dr. Cai helped set up a 1yr program for graduates. The students go to China for one year and they teach English a few hours a week and the other time is allotted to follow clinicians in the University Hospital. It is not clear if the graduates can needle, but it is an extraordinary learning experience to see the integration of Western and Eastern in the hospital. The students are paid to teach English and they can use this money to travel on weekends or the two-month break they are allotted.

Margo also graduated from the herbal program and she has plans to go back to her home country of Poland. From what Margo understands, she might have to get a PhD to practice Oriental Medicine, but it is very accepted by the people in Poland. However, the European Union is also very strict in authorizing certain herbs to be used in practice, so she might have to modify her formulas to omit any animal products, however other herbs can be substituted. These ladies are intelligent and great with patients, and I wish them much luck in the future!  

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Note: The pictures are of Nicole and Mike (He graduated MSAc and is practicing chiropractic and acupuncture in Naperville, Ill.) and Andrea, Dr. Cai, Nicole, and Margo.