Archive for tag: clinic

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.


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.


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.


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.


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.

Acupuncture Is Kind of a Big Deal

With at least two distinct "appreciation" events in the next two weeks, Acupuncture and oriental medicine seems to be powering its way into the integrative healthcare arena. Currently at NUHS, an acupuncture awareness campaign is giving AOM students, faculty, clinicians, and interns of all kinds of an excuse to sport an unmistakably fashionable bow tie. That's right, in addition to the pristine business professional wear and white coats, always part of our clinic attire, you can also catch us pinning on a snazzy white and black yin-yang bow tie from now through November 1st. It goes with everything.


If gawking at odd bow ties isn't enough to grab your attention and get you thinking more about acupuncture and oriental medicine, then how about some free treatment? That's right. From October 27th to November 1st, all new patients to the NUHS AOM Clinic can receive a free treatment. This is a great opportunity for anyone who's been considering giving acupuncture a try, but hasn't been willing to shell out the usual $25. Just make sure to schedule ahead of time -- free generally means "busy" around the clinic!


Why do we need to raise awareness about acupuncture (and all of oriental medicine)? In a 2014 National Health Interview Survey report, researchers revealed that 14 million Americans have tried acupuncture. That sounds like a lot, but it's really not. That's only 6% of Americans! What's holding back the other 94% of the American population? My guess is needle phobia. Who wants to be poked and pricked? Not even I like needles, and I use them every day.

Neporent, Liz "A Close-Up Look at Acupuncture for Pain." ABC News. April 22 2014. Web. April 25 2014

Thankfully, needlephobes like myself are not holding back the growth of acupuncture in the United States today. Lately we've been finding needles everywhere. The military is hiring acupuncturists, veterans' clinics are treating PTSD, and pain management and cancer treatment centers are flooded with requests for acupuncture services. Even research studies, in English, showing the efficacy and safety of acupuncture are appearing at a rapid clip. It seems like the west is doing a good job proving the east already knew what it was doing. Acupuncture can treat just about everything.

Ladies and gentlemen, the people have spoken. They want to be poked.

To find out more about these awareness events at NUHS, and to keep up with the happenings of our program on campus, check out the NUHS AOM Club Facebook page.

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."


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....

Choosing Your Intern

You've made the first move. You've called to schedule an appointment in the AOM clinic. Just as you think you're almost done with this first critical step, the receptionist throws a massively important, yet completely unexpected, wrench in your plan. "Which intern are you looking to schedule with?"

Oh. My. God. What do you do? Which name do you say off the top of your head? As you feel the pressure mount in those two seconds of silence on the phone, your brain quickly scans the names, personalities, general skill levels, and specific competencies of every student you know at NUHS.


It might not seem like a big decision to some, but for many patients, your intern will make or break the entire appointment. I've heard it all in the halls of the clinic, "He got a D on that Point Location Exam, so I don't want to schedule with him!" "She's the only one who follows up needling with tui na every week--I want her!" "I only (or, I don't) want my best friends seeing me with my pants down." If you're bringing sensitive people--the elderly or young children--then even appearance might matter. If I scheduled my kids with a super-tall bearded man, they might run outside and hide by the swans!


If you haven't thought about which intern you will choose for your first or next acupuncture appointment, here is a handy guide to help weigh your options. No, I'm not going to provide a rating list of each intern in clinic this trimester, complete with names, pictures, and assorted blasphemies or accolades. Instead, I'm going to walk you through the options that may or may not be important to you in your decision-making process.

  1. Do you want your friends to see you naked?
    Most of us don't mind in a medical setting, but if you get stage fright in this arena, consider it a factor. If you can't relax, then your acupuncture treatment can't be fully effective.
  2. Do you want to build a long-lasting relationship with just one intern?
    Don't select someone who's graduating at the end of the trimester. Many of us are part-time, which means that we will be a regular presence in the clinic for a year or more.
  3. Are you only concerned about having the most informed, top-of-the-class intern right now?
    Then go ahead and choose that fabulous intern who has the most experience with add-on extras--if you can get into her packed schedule!
  4. Should your treatment philosophy match your provider's?
    I think so, and I consider this when scheduling an appointment myself. Do I get a good feeling from this person? Do they ooze positive energy? I come to the clinic to build my qi, not to have it stolen.

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Now for the great part--there isn't one intern who fits every criteria! This is wonderful news, because it means that a variety of options exist for each patient who walks through the door. Each patient is different, and each intern is different. If you've tried acupuncture once, but just didn't get that great feeling, then try again with someone else! If you were lucky and hit it out of the park with your first intern, then stick with that person, or ask him or her for a referral for another intern who treats in a similar style.

Good luck, and happy hunting!

Want to Freak Out an MD?

2014-07-03_yurasekWhen they ask you why you came in for an appointment today, go ahead and let them know that your urine is coming out in long, clear streams, and that your dreams have been creepily vivid this week. Tell them that your bowel movements are light brown, formed, and coming with ease twice per day in forearm lengths that would make Dr. Yurasek proud. Mention that you've been feeling kind of cold and that you can't stand being out in the wind. That heaviness in your arms? Mention it.

Dive straight into the rest of Oriental Medicine's famed "Ten Questions," noting whether you've been extra hungry, not so thirsty, frigidly anti-sexual, exhausted from periods with quarter-sized black clots, or muzzy-headed in the afternoons. It all matters. If you're in an AOM clinic, these are the types of things you can expect to be asked by your acupuncturist or herbalist. No one here bats an eye when patients share the color and consistency of their bowel movements. In fact, if you withhold that information, we can't really help you very well.

Here they are, in detail but translated by me:

The Ten Questions

  1. 2014-07-03_outlineDo you feel hot or cold, or do you experience fever or chills?
  2. Are you sweating and is it during the day or at night?
  3. What's up with your head and face? (EENT)
  4. Do you have any pain anywhere?
  5. How's your urine and stool coming out?
  6. Are you thirsty? Hungry? Got cravings?
  7. How've you been sleeping?
  8. Anything noteworthy going on in your abdomen/thorax? Who says "thorax"?
  9. What's up with your gynecology? If male, you can put "N/A," thank goodness.
  10. 10. General/Past Medical History (in case we didn't cover it all yet)

Your acupuncturist or herbalist not only wants to know these things, but also actuallyneedsto know many of these things in order to properly diagnose your condition and begin a treatment plan. If you have long, clear streams of urine, loose stool, weak knees, a sore lower back, and feel cold all the time...well, we know what's going on. No, I'm not going to tell you here. Look it up. Better yet, visit an acupuncturist!

So, if you're in an AOM clinic, have your thoughts on these vital topics prepared beforehand. Otherwise, you might be so thrown off guard by some of the Ten Questions that you can't formulate sentences. That's actually fine, because none of the 10 questions directly correlate to grammar skill level. Thank goodness, right? However, if you find yourself in the office of an MD, keep in mind that you might not want to just jump right in with details about where you are in your menstrual cycle and how gassy you've been, if your chief complaint is seasonal allergies. Just a tip, from me to you.