Archive for tag: acupuncture

How a Clinic Internship Works

I get this question all of the time: "Do you acupuncture people yet?"

Yes, kind of, not really, I don't know what I'm supposed to say exactly. Do I put needles in people? Yes, of course. Should I? Well, that's where you've got me. Technically, I'm not a licensed acupuncturist yet, so I take that to mean that I can't charge people for acupuncture yet. Is it safe for me to needle people? Well, I do have my Clean Needle Technique certificate filed away somewhere....

2014-07-23_internDo I know what I'm doing? Can I help someone feel better? I don't want to be a pretentious jerk and assume the answers are "yes" here, but over the past year I've certainly had some good feedback. As a sometimes full-time and sometimes part-time student in the acupuncture program, I'm somewhere around Tri 5. I've completed a large chunk of the coursework, the whole observation phase in the clinic, and now I'm actively practicing on everyone who schedules an appointment with me in the AOM clinic on campus.

For the next year, I'll continue along in this internship, enjoying the opportunity to test out treatment strategies, hone my diagnosis skills, and figure out if "patient consents to treatment" actually belongs in the "A" or the "P" portion of the SOAP note. I'll do intakes; I'll form diagnostic impressions; I'll pow-wow with Dr. Cai, Dr. Stretch, and any other clinician I can find. I'll needle patients; I'll moxa their cold feet; and I'll do as much moving cupping as my forearm strength permits. If you're really special, I'll do tui na and I'll gua sha you afterward. Want some herbs? Sure, we have raw, granules, or patent pills. Right this way!

While the patient visits are the most important and most fun parts of the clinic internship experience, the clinic lottery is the part that causes the most anxiety among the interns. "Will I get my same shifts next tri?" "Which clinician will I work under?" "Which interns or observers will be on my shift?" All of these panic-stricken questions and many more can be heard all over campus right now -- the infamous Week 12 clinic sign-up and resulting lottery has arrived!

Photo of Stroger buildingSure, interns get to sign up for their preferred shifts and locations for clinic internships. We AOM students have the luxury of choosing the on-campus Lombard Whole Health Center clinic or driving to Stroger (Cook County Hospital) in Chicago for an off-site experience. My 45-minute commute is plenty, so I try to keep it simple and stick to the main campus. There we all are, fluttering around the sign-up sheet in the clinic lounge room, which is busting at the seams on a regular day, elbowing the interns who are actually trying to sit nicely and write SOAP notes that day.

If all goes well, there is a nice white empty slot shining and waiting just for you on the day and time that you've decided would be perfect for your upcoming trimester. In reality, someone else probably agreed and already signed up for that one. In the end, many interns are able to secure an acceptable shift and everyone survives the sign-up week. Some lucky individuals end up in the clinic lottery, where randomly drawn numbers allow devastated interns to play a sort of game-show rendition of "This will be your life next trimester."

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In my two years at NUHS, we haven't lost anyone yet! The sign-up process can be stressful for some, but by the time the next trimester rolls around, we're all just excited to start treating our patients and working with our clinicians to hone our skills. I have one more year of this endearing learning process, and then it's out into the real world for me (again). No more clinicians to ask questions of, no more easily accessible chiropractors down the hall to consult with on orthopedic issues (thanks, Dr. Anderson!), and no more half-days of work! Maybe this whole clinic deal is pretty great after all....

Why Are We So Wimpy?

2014-06-10_wimpYes, I said "we." I'm lumping you all in with me and almost everyone else I know. We're wimpy. My sister said it best several years ago in a comment about the "wussification of America." No, I'm not sure how to spell that. She was speaking about the general wussiness of people these days, and I'll see that new word and raise it to another contextual use.

I'm sure you know what I'm talking about. If you have had a baby in the past 10 years, you've certainly had to explain to a grandmother (your kid's or otherwise) why baby has to ride in the car seat for every little trip. "Yes, grandma, I know we're just riding up the street to the corner store. Yes, she still needs to be strapped into her car seat. Just because." Grandma undoubtedly replies, "I never strapped your father into a car seat, and he lived. He would ride all the way to Florida to visit Aunt Ida every year and nothing ever happened to him." Then simply to justify my own wussiness, I make up something about how I'll be arrested if the police see me with my kid riding on my lap.

2014-06-10_signSome of you might not be convinced about the car seats. They're important. Even I strap my kids into those things just to ride up the street, and I don't consider myself a huge wussy. Just start extrapolating this theory, though, and you'll surely jump onto the "wussification of America" bandwagon. We all drink light beer. Every kid gets a trophy. They cancel school when it snows. I'm so hot walking the 10 feet from my air-conditioned car to my air-conditioned office. I have to wait 3 whole seconds for my Facebook page to load on this old phone. Waaaah.

How does this relate to Acupuncture and Oriental Medicine? Well, the wimps don't leave their wimpiness at the door of the clinic. That is for sure. I can write this post without fear of offending anyone, because I, myself, am a needle wuss. That's right. I don't want to feel the needles. I'll needle you, but don't you try to needle me.

Clearly I am not alone. Sure, you have a few patients who never flinch when you insert a needle. They never complain that something hurts or feels weird. These are the lovely "exception" patients, and they are few and far between. Most of us recoil in pain -- pain that is really just an unfulfilled apprehension of pain -- with the insertion of each needle. At first, I liked seeing this reaction from patients, because it justified my own wimpiness. Now, though, I've evolved. As I become less wimpy about needling myself and letting others needle me, I think I subconsciously expect more of my patients, too.

2014-06-10_smokeThe people in Nicaragua never flinched. We would jab those needles right into the sore back or the tired feet, and the patient would hardly notice. Are Nicaraguans simply a stronger people than Americans? Probably, but I didn't stop there. No, what about the Chinese needling? So deep, so hard, so scary for most Americans. Are they inherently stronger than us, too? They want to feel that moxa until it burns a blackened memorial into ST36. I would move to Japan, home of "shallow needling," to avoid those 6-inch needles I've been told so much about from the Chinese professors and clinicians.

2014-06-10_needleNo, I don't think it's that Nicaraguans are freakishly strong or that Chinese people are particularly masochistic. I just think Americans are caught in the throes of the recent trends towards wussification. Be careful, don't get hurt; don't let the sunshine get you! I reject wussification insofar as I legally can, but I am still and will always be one of the wimpy ones in the clinic when I'm on the receiving end of that needle business. So, if you're afraid of needles and therefore have not yet tried acupuncture, this post is for you. If I can do it, you can do it.

Why There is No Such Thing as Sham Acupuncture

I get really annoyed when I'm reading the results of a scientific study about the effectiveness of acupuncture, and the author concludes that actual acupuncture was "not significantly more effective than sham acupuncture." What they seem to be saying is that acupuncture is not effective at treating X condition. What they are actual discovering is that needle insertion almost anywhere in the body will have an effect on the body's condition, often providing relief from X condition.

I like this part. As Dr. Kwon always told us in Point Location class, you can still help the patient even if you don't stick the needle in the exact acupoint. This realization saved my sanity on more than one occasion when trying to palpate and count thoracic vertebrae to locate the oh-so-important points of the Governing Vessel running up the spinal column. It's supposed to be located at T6, but T7 will be good enough? Awesome. Thank you for your flexibility, ancient wisdom.

So, back to the studies that drive me nuts. Here's how they commonly shake out:

Exactly 100 patients were studied for chronic knee pain, with 25 receiving no treatment, 50 receiving actual acupuncture (inserting needles at specifically proscribed points), and 25 receiving sham acupuncture (inserting needles randomly in the body). Guess what? The patients receiving no treatment did not experience improvement. The patients receiving actual acupuncture reported a 50% improvement, and those receiving sham acupuncture reported a 45% improvement.

I call that good news. The study concludes, instead, that actual acupuncture is not significantly more effective than sham acupuncture at treating knee pain. Wrong. What they actually did is prove Dr. Kwon right -- not that he needs any additional validation, seriously -- that even when needles are inserted at the "incorrect" location, acupuncture still has therapeutic benefits for the patient. Is the goal of an acupuncture treatment for knee pain simply to eliminate the knee pain? Not exactly.

Any time acupuncture happens, that patient's body experiences a shift in energy. We can usually feel a difference in the person's pulse after treatment, compared to before. The qi (energy) has moved, and in western terms, circulation usually improves. Sure, the knee pain is improved, but the patient might also sleep better than usual that night, awake with more energy than usual the next day, or even notice that a new head cold has resolved overnight.

Were these other effects coincidental? Maybe, but probably not. Any acupuncture is better than no acupuncture, and the results of studies comparing no treatment, sham acupuncture, and actual acupuncture will often reveal this truth. In fact, this little "secret" is why I'm not against other practitioners doing acupuncture on patients. We've all heard the buzzword "dry needling," which is when say, your physical therapist needles your arm when your elbow isn't healing as nicely as you'd like. I know several chiropractors who have completed the 100-hour certification in acupuncture, and they can often be seen sticking some needles into a sore back muscle.

Some acupuncturists are completely against this concept of non-acupuncturists needling patients, but I'm pretty much OK with it. I know the patient is probably receiving some benefit regardless of whether or not the needle goes in at an exact acupoints. What's important to me is that the patient is aware that dry needling or someone sticking some needles in where it hurts is not all that acupuncture has to offer. Those techniques have benefits, but not the full array of benefits that needling specific acupoints on specific meridians can produce.

So, if you know someone who's been needled before and didn't experience a great symptom reduction, it's still worth their time to try acupuncture from an acupuncturist. Crazy, I know. It's not that other providers are doing anything wrong; it's just that they aren't receiving the more complete system of treatment via acupuncture that we acupuncture students use.

Jabbing Nerves with Needles

"I hope the points aren't just nerves being shocked by needles," I said to AOM classmate Irene. As one of the few AOM students who originally came into the program to focus on herbal preparations and dietetics, I felt particularly uninformed about this whole acupuncture thing. So, there in one of the first courses on the theory of point energetics -- what the acupoints do and how they do it -- I finally vocalized, albeit in a whisper-like fashion, my growing fear: Maybe there's no meridian or point energetics beyond just sticking a needle into a nerve and hoping it stimulates something productive in the patient's body. Sure, that might still help, but it certainly doesn't have the mystique that interested me in the first place.

2014-03-14_ancient"Moving blood and qi," "balancing energy," and "harmonizing yin and yang"...these concepts are intriguing, promising, and yes, darn near magical in my opinion. If we're just jabbing people with needles and shocking them wildly, then I'm not sure I have the buy-in that a 3-year master of science in oriental medicine degree requires. So there I sat, giving power to my secret fear by speaking it aloud, not knowing what Dr. Yihyun Kwon was going to say to pull me back over to his side of the fence, and hoping that there was something more -- more ancient, more Daoist, more qi-related in any way. (Spoiler Alert. Dr. Kwon wins!) 

Irene surprised me with her response, which I recall as being something along the lines of, "So what if acupuncture is just stimulating nerves with needles?" How could she be so callous to this deep fear that I'd been subconsciously fostering for the first three months of our program? Didn't she understand that I was sitting there, suffering in silence, desperate for some oriental medicine justification?

What Dr. Kwon went on to explain in that first Energetics class, and even more so the following year in Neurophysiology of Acupuncture class, was a concept that bridged the gap between the mysticism and the mundane. He simultaneously satisfied my cravings for evidence-based medicine as well as ancient tradition. Dr. Kwon = 2. Juli's irrational fears = 0.

Photo of Dr. Kwon with studentsYes, he explained, some points are located right beside or above a nerve -- grazing it ever so slightly and eliciting that loved or hated sensation we call "de qi," when energy arrives along that meridian. Further research and dissections have confirmed that many of those points not located at a nerve are actually located exceptionally close to an artery or vein. Here's where he blows my mind in 3...2...1....

Next, he tells us that these vessels and other structures harboring acupoints are essentially wrapped up in nerve fibers themselves. Yes, readers, we've come full circle in Juli's understanding of neurophysiology (which doesn't take long). Many acupoints are on a nerve; those that aren't, still kind of are.

And now to process this information.... Do I hate this answer? Does it ruin the grandeur of ancient energy meridian theory? Nah. I took the news fairly well, all ignorance and expectations considered. In today's health care climate, I like that modern science keeps proving acupuncture theory to be true. Time and time again, I see modern western research pointing to the validity of traditional medicine. At the end of the day, or the century, who doesn't like being told, "You're right"?

A Needle in the Ear or a Cigarette in the Hand

Can acupuncture help you stop smoking? Maybe. Like most smoking cessation plans, the most important part will be whether or not you firmly desire to quit using tobacco. If you have the will, then acupuncture might just have the way.

2014-03-05_cigActually, smoking cessation is one of the more long-standing mainstream applications of acupuncture in the United States. My husband recently asked me for ideas about the effectiveness for his co-worker who has been trying to quit, and my mind has been making the connections ever since. How does it work? Will it work? Which points should be used? How often will he need treatment? Can he do some of the work at home between acupuncture sessions?

Naturally, being just a student, I didn't know the answers to these questions without looking into them myself. Now that I feel like I have a handle on some of these factors, I'll go ahead and give you lowdown. Of course, I'm not telling anyone to try this at home, but this is what your acupuncturist might do if you walk into the clinic and ask for help in your journey to drop the cigarettes for good.

First, let's talk about the mechanisms. Why does a needle going through your skin make you want to stop smoking? Actually, there are multiple methods to this madness. On one hand (literally, on the side of your hand, via an acupoint called Tim Mee) a needle can actually make your cigarette taste bad. Personally, I think they already taste bad, but apparently people who smoke tend to like the taste. Moving on, if changing the taste of a cigarette from lightly ashy to repulsively garbagy isn't strong enough magic for you, there are other things that might still work for your stubborn self.

2014-03-05_ear 200Next, auricular acupuncture can help control your cravings, addiction, and withdrawal symptoms while trying to quit. Think ear piercing with a purpose! While ear acupuncture can sound even scarier than regular body acupuncture to the faint-at-heart-newbies, rest assured that the needles are hair-thin and barely felt. I should tell you that electro-stimulation of these auricular points is also commonplace. Some commonly used ear points for smoking cessation include the following: Shen Men, Sympathetic Autonomic, Point Zero, Endocrine, etc. Your acupuncturist will add additional points depending on your individualized condition. Nope, auricular acupuncture for smoking cessation is NOT necessarily a one-size-fits-all treatment.

Now, what can the patient do at home to keep these positive no-smoking juices flowing between acupuncture sessions? Luckily, we have a plan for that, too. If you've never heard of ear seeds, you will if you seek help to quit smoking from an acupuncturist! Small seeds or magnets (fancy name--auricular pellets) with clear tape backing are stuck on the above mentioned ear points, and then the patient is instructed to squeeze them several times a day until they eventually fall off. If you shower regularly, this is generally in around three days. If you're looser with your bathing schedule, you might keep your home care going for a whole week I suppose. But, let's just pretend everyone showers more than once per week.

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Back to the main event: Can acupuncture help you quit smoking? It really is UP TO YOU. Unless your acupuncturists steals your cigs, robs you of any available currency, and prevents you from bartering in the streets for your next nicotine fix, it really is in your hands. Studies show a variety of outcomes; some are very positive indeed. If you're ready, call the clinic!

References:

Effect of Acupuncture on Smoking Cessation or Reduction: An 8-Month and 5-Year Follow-up Study. Preventive Medicine, Volume 33, Issue 5, Pages 364-372. Dong He, Jon I. Medbø, Arne T. Høstmark

Acupuncture to Stop Smoking - Yin Yang House