Archive for tag: acupuncture

Giving a Brazilian at Stroger

"Give her a Brazilian in Room 1!" This is the new catchphrase around Stroger. That's right, we're giving Brazilians at the pain clinic in Cook County Hospital. I occasionally worry that a passing doctor thinks I'm waxing ladies in the treatment room, but the concern quickly fades as I get down to business. This Brazilian is all in the ears, and the only intimate part is the bleeding. I always think bleeding is sort of a personal interaction.

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According to a successful acupuncturist in Brazil, the best treatment for relieving joint pain with heat signs is to tonify the energy of the major internal organs, direct it towards the affected joints, and then bleed it out of the body. How do we do this exactly? Here's a sample case: inflammatory knee pain, let's say on the left knee. It's painful, the area is red, swollen, and warm to the touch. The patient often reports feeling warm, the pulse is slightly rapid, and the tongue is often red.

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The Brazilian technique is essentially a three-step process. First, we needle the following points on the ear of the non-affected side: Shen Men, Sympathetic, Liver, Kidney, Heart, and Lung. Six needles so far, if you're counting. Then, we needle the corresponding painful body parts on the ear of the affected side of the body: Knee. OK, we're up to 7 needles so far. Totally doable. Now we let those needles rest for a while while we enter the SOAP note in the lovely electronic medical records system at Stroger.

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After about 10 or 15 minutes, we take those needles all out. Next step, we get intimate. It's time to bleed the Ear Apex on the affected side. I like to give it a few hard squeezes to ensure I'm stealing as much hot blood out of this person's body as possible. Don't worry -- it's usually just a drop or two.

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What happens next? Well, it varies. Often times, though, it goes like this. The patient stands up, wiggles around to "test" for any perceptible changes in pain level and range of motion, and starts to smile. "I feel better!" Pain levels are dropping from 10/10's to 4/10's in that 15-minute treatment time. Is it unorthodox? Somewhat. Is it effective? Seems to be. Will we keep giving Brazilians at Stroger? You bet.

Celery and Needles

What could the two possibly have in common? No, you guess first. Something to do with swords? Nope. OK, I'll tell you.

2015-02-20_1I was cooking dinner last night, and the recipe did not call for celery. I had a flash memory of a friend on Facebook posting that she added a bunch of random things to the granola she was making that day, because she wanted to clean out her pantry. I've been there. Two handfuls of raisins kicking around in the bottom of the snack pantry (in a container - I'm not that gross)...about a tablespoon of crushed pecans that I'll save for years rather than throw out -- come on, those things are expensive! Into the granola they go....

There I am, cooking dinner, the dinner that did not call for celery. This is about to relate to acupuncture, just wait for it. I look into the fridge and notice I have two giant packs of celery from the previous two weeks. My son had been on a celery kick for months, inhaling several stalks per day, and of course he suddenly hated it as soon as I stocked up. "I'll just chop some up and toss it into the pan with the onions and garlic I'm sautéing for the stuffed peppers recipe." Boom. In it goes.

2015-02-20_2No harm done, right? Maybe.... In the Traditional Chinese Medicine branch called Dietary Therapy, we learn the nature and properties of foods from kelp to congee and oats to oranges. Here's the medicinal profile for celery according to TCM: cooling, sweet, slightly bitter, benefitting the stomach and spleen, calming an irritated liver, improving digestion, drying dampness, purifying the blood, reducing nervousness and vertigo, clearing heat from the eyes, urine and mouth, and relieving headaches caused by stomach heat and stagnated liver qi (Pitchford, 2002, p. 539).

That would have been fine. Even if you didn't understand most of that, trust me, it would have been fine. Who doesn't have some stomach heat and stagnated liver qi these days! Then, as quickly as I tossed the chopped celery into the recipe that didn't call for it, I heard Dr. Zhu's voice in my head, reminding us that we cannot just throw in some extra needles just because we opened a 10-pack!

2015-02-20_3What's the big deal about haphazardly adding things in after the recipe (yes, we could call an acupuncture point prescription a "recipe")?

As Dr. Zhu explained, the point prescription is just that -- a prescription. You should take it seriously and respect the balance and harmony of the points that are working together. There are master-couple points in there; I saw a guest-host thing going on. I know she's tonifying the mother and sedating the child on the Lung channel. Someone said "extraordinary." Seems like it's getting crazy, but really it's not. It's very calculated...complete and perfect.

2015-02-20_5needles _smallNext time you find yourself in the kitchen with some extra celery to use up, are you going to throw it into the pan when the recipe doesn't call for it? Maybe... But, the next time you acupuncture interns find yourselves in rooms full of open packs of needles, I hope you do the right thing and leave them on the clean field instead of just adding in the 3 extra opened needles. Just don't tell Dr. Kim--he does not like wasted needles!'

Pitchford, P. (1996). Healing with whole foods: Oriental traditions and modern nutrition. Berkeley, Calif: North Atlantic Books.

This One Time, at Stroger

Dr. Yurasek and I scrubbed into the isolation unit, donned our masks, and needled an in-patient right in her hospital bed. I knew that shift would be different. It was only my third day, but it just felt different when I punched in that morning...and I was right!

2015-02-05_1Between our usual out-patient pain clinic cases at Cook County Hospital, Dr. Yurasek, the other morning interns, and I were discussing some of the more remarkable results achieved with auricular acupuncture. That's putting needles on ears, for the laypeople reading today. He told us about a patient in a wheelchair who rolled in with several bullet wounds and walked out the same day after the acupuncture treatment. We told him about patients whose pain level went from 10/10 to 0/10 after their acupuncture treatment. It was basically "one time at band camp" day at Stroger.

Dr. Yurasek was explaining that these types of staggeringly effective results are the reason that acupuncture has been making its way into the world of western medicine. Specifically, he said it was the "portal to acupuncture ecstasy." That's actually the start of an entirely different "one time at Stroger" story from last week... but we aren't talking about that one here.

The point was that with the obvious decrease in patient pain after a 10-minute needling and tui na treatment, it's hard to shut the door in the face of the acupuncturist who wants to treat the people. Let us into your hospitals! Share your space with us, MDs! We were all on board... but how would we get the administration to give us the time of day?

2015-02-05_2Then, the call came. The sixth floor had an in-patient in acute abdominal pain, and her doctor wanted the acupuncturist to come up and lend a hand -- a hand with a needle at the end of it. And, since they called Dr. Yurasek, it would be a big hand with a really, really big needle on the end of it. We all know he likes those 6-inch needles. I don't even near-faint anymore when he whips them out and drives them into a patient's leg. I still look at the other side, though, expecting to see the needle sticking out back there... I do still do that.

I had just hooked up my patient to the E-Stim machine and dimmed the lights in her treatment room, when Dr. Yurasek peeked his head in my room and said, "Let's go." Where were we going? I didn't know yet. He calmly said, "There's an inpatient on the 6thfloor in acute abdominal pain, and we're going up to needle her." Alrighty. If you say so, sir. I walk next to him, fumbling through the pockets in my white coat, knowing I probably needed to be bringing supplies or something.

Halfway upstairs he, very casually, mentions that the patient is actually in an isolation unit, and we'll need to take extra precautions. OK, ummm, is it too late to go back downstairs? What? Thoughts of bringing home some exotic virus (other than the ones I've already had) to my kids were flying through my mind.

2015-02-05_3Well, now I'm so nervous that I don't even know where I am. Where are we heading? East wing? West wing? Where's the lake? Finally, we make it to her unit. The nurses glance up at us like, hey, no big deal, go on in. She's through that set of doors, and then through that next set of doors... the ones with those red signs taped to the window. OMG. "Droplet isolation"! I don't even know what that means, but I'm nervous. Very nervous. We scrub in, the nurse finally steps in and helps us with our facemasks before we tied them on backwards, and basically pushed us through the next set of doors.

Well, too late to back out now. Here we go. Luckily I had needles in my pocket. Or he did, I can't even remember. The next 30 minutes were a blur, mostly because I was nearly passing out from the recirculating carbon dioxide in my facemask. How do people wear those for extended amounts of time? Clearly I was doing it wrong. First timers, right here.

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"Where's your worst pain right now," Dr. Yurasek asks the patient, who I definitely thought was unconscious when we first walked in, splayed out in her bed with the usual useless hospital gown covering her nothing. "My back, and my leg, all the way down to my foot," she says. Well, she's conscious. Great news for my burgeoning anxiety. Abdominal pain, back pain, she's got it all, but her back hurts the most right now. So, we treat her back pain. Cue the 6-inch needles into the ancient secret lock-and-key points now called "Gall Bladder 30" and Gall Bladder 34." Sciatic pain relief on the way!

The patient is in less pain and is visibly more relaxed in her body tension. She was in the middle of telling us a story, but then she suddenly passed out asleep. OK. As long as she's not dead, I'm going to make it. I run around like a crazy person in a crazy mask looking for a gauze pad so we could take the needles out, and finally, our job is done here. We walk back downstairs to the outpatient pain clinic and resume our day.

"How's your internship at Stroger going," people keep asking me. Awesome. It's freaking awesome. If you have the opportunity to intern at Stroger, and you're not doing it, you're missing out.

What Can Acupuncture Do for Me

2015-01-22_handsAs soon as I say, "I'm studying acupuncture," their eyes light up. Everyone likes the idea of acupuncture. It sounds exotic, ancient, and trendy all at the same time. What could be better? Yes, the interest is there, but so, undoubtedly, is the follow-up question, "What can acupuncture help with?"

Gee, let me think. My first instinct, based on clinical and personal experience, is to excitedly shout "EVERYTHING" in someone's face. We all know that's not helpful, not specific, and usually not socially acceptable. Instead, I try to reign myself in and itemize a few conditions that might be of concern to the individual in question. My answer then comes out sounding like, "Oh, several things...trouble with sleep, irritability, irregular periods, pain, you know...basically everything." I just can't resist throwing that all-inclusive ending on there.

2015-01-22_wallMaybe I'm not way out of line in doing so. In ancient China, obviously Chinese medicine was the entire medical system, including preventive care, acute care, chronic care, you name it. Your acupuncturist could needle your face, moxa your feet, gua sha your shoulders, tui na your back, and even perform certain surgeries. Back then, "What does acupuncture treat" would have definitely received my favorite answer, "EVERYTHING!" Although, that's probably too rude and aggressive for ancient China. They probably would have responded with something much more humble, and then surprised the pants off you with their amazingly effective acupuncture treatment.

2015-01-22_symbolLet's look for a compromise. In America today, you can't just walk around saying that something that's not a drug can treat, prevent, or cure a disease. You can't say it. So, what can we say? In these delicate cases, I defer to the World Health Organization, which lists conditions that acupuncture has proven to be an effective treatment through controlled trials. Although the list we all seem to use is incredibly old -- from 1996 -- we continue to see additional conditions helped by acupuncture in individual studies such as those found via www.pubmed.gov.

Here's our old starting list:

  • Adverse reactions to radiotherapy and/or chemotherapy
  • Allergic rhinitis (including hay fever)
  • Biliary colic
  • Depression (including depressive neurosis and depression following stroke)
  • Dysentery, acute bacillary
  • Dysmenorrhea, primary
  • Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
  • Facial pain (including craniomandibular disorders)
  • Headache
  • Hypertension, essential
  • Hypotension, primary
  • Induction of labor
  • Knee pain
  • Leukopenia
  • Low back pain
  • Malposition of fetus, correction of Morning Sickness
  • Nausea and vomiting
  • Neck pain
  • Pain in dentistry (including dental pain and temporomandibular dysfunction)
  • Periarthritis of shoulder
  • Postoperative pain
  • Renal colic
  • Rheumatoid arthritis
  • Sciatica
  • Sprain
  • Stroke
  • Tennis elbow

Plus, for our reading pleasure, the World Health Organization also gives us some hopeful additional categories. They list over 60 additional conditions and diseases that acupuncture has been demonstrated to be effective for, but for which additional research is needed. There are about 15 other conditions for which acupuncture has been shown effective for in individual cases, or for which conventional treatment is difficult or ineffective.

2015-01-22_checkSo, next time someone asks me what acupuncture can help them with, I'm going to give in and shout, "EVERYTHING," at them. After all, odds are I'd be right. Does it treat this? Check. Does it treat that? CHECK!

Put Those Hands Together When You Pray

If you don't pray, put them together anyway. In the age of anything goes, I've taken to the lazy practice of praying silently in my head while lying in bed at night. I don't know where my hands are exactly, but they sure aren't folded nicely in front of my chest like the iconic prayer image of the olden days.

Who cares? Why bother pressing your hands together and holding them in that fairly awkward position that drove me nuts as a Catholic school kid? I'll be the first to admit that I let my fingers fall and intertwine into the sloppy prayer paws pose as soon as the priest looked the other direction.

Now I realize I was screwing myself out of some real benefits. Sure, God was probably disappointed in my faulty direction following, but I'm not focusing on the spiritual deficit here. I'm focusing on the physical and even the psychological benefits I -- and many other lazy prayers -- had been missing out on all my young life.

This whole conversation hinges on one important point -- an acupuncture point -- called Pericardium 6, or "PC6" as we call it, because again we're all too lazy to stick to the formalities in life. What does PC6 have to do with prayer paws (as my kids call them)? This now famous spot, two inches proximal to the inner wrist crease, has been dubbed the most researched acupoints of the modern day. You know those "anti-nausea" motion-sickness type bracelet bands, with the ball that presses into the inner wrist? That thing's stimulating good ole PC6.

Why is PC6 such a beneficial acupoint? Our trusty guide to acupuncture points and meridians and their energetic functions is a beefy, rust-colored book usually referred to by its author's last name, "Deadman." What does Deadman say about PC6? Oh, nothing too exciting. Just that it treats all diseases of the chest, particularly the heart, but also benefits the lungs, too. It can be used for heart surgery analgesia. What? Yes! No anesthesia necessary...just squeeze PC6 for me while I go under the knife!

In TCM terms, PC6 "unbinds the chest and regulates qi," "regulates the heart and calms the spirit," "harmonizes the stomach to relieve nausea," and "clears heat." It's indicated in conditions such as heart pain, palpitations, cough, asthma, insomnia, anxiety, abdominal masses, fevers, malaria, irregular menstruation, and swellings in the armpits. Nothing important there, right? Not! PC6 does just about everything you could want an acupoint to do.

During a recent advanced seminar class with Dr. Robin Fan, we discussed the benefit of stretching the Kidney meridian in cases of heel pain. Suddenly, all I could picture was the traditional prayer pose--hands out front, pressed gently together, stretching and stimulating the bulk of the Pericardium meridian!

It makes sense. What is the function of prayer if not to calm the mind and spirit? It's not just Catholics and other Christians who have always used this prayer pose, either. As my mind wandered -- sorry, Dr. Fan -- around the globe, I saw the Chinese practicing qi gong poses, the Indians practicing yoga poses, etc. Every tradition I could think of involved some use of this position.

In anthropology, when we see similar customs or values amongst a variety of cultural groups around the world, we call those core elements "cultural universals." In other words, everybody's doing it. Why? The answer is one that, despite my need to create an evidence-based practice, I've always secretly promulgated; sometimes, you don't need to sit around waiting for a formal research study to prove a truth. It's lovely that western medicine has put together some studies that do show the efficacy of PC6 in some conditions, but I'm not waiting for them to prove the rest. I'm going with Deadman and the ancient world traditions on this one.

Pray on, prayers!