No one likes to be wrong. No one likes to admit that his or her
medicine is not the best. When a patient walks into the room
seeking treatment, we each want to be the one to say, "Yes, we can
help you." While acupuncture has successfully treated the masses
for thousands of years, and has been recommended by the World
Health Organization for dozens of conditions and diseases, it's not
the only tool in the shed in 2015.
On Thursday at Cook County Hospital, I sat at the computer in a
treatment room entering the subjective information from an existing
patient presenting with a new chief complaint -- left calf pain.
We'd treated her in the acupuncture wing of the outpatient pain
clinic before, but her chief complaint was usually lower back pain.
Initially, I thought "another case of sciatica," as I worked
through her SOAP note and mentally scanned the best acupuncture
points for the job.
"Sharp pain in the back of my leg," she said, gingerly touching
her left calf. I asked, "When did it start, and have you had this
pain before?" "Yesterday, and NO," she snapped back at me. "It's so
swollen and the pain is sharp right here," she added. She confirmed
that there had been no trauma to the area, and I released my grip
and let the pack of needles slide deeper down into my lab coat
I'm kind of new here, and I readily admit that my weakness as an
acupuncture intern is ruling out contraindications and sorting out
red flags before I start sticking needles into the patient. Can I
still needle you if your blood pressure is 150/90? Some books say
yes, some sources say no. Acupuncture lowers blood pressure, so
shouldn't we go ahead and do it? Refer out! Confusion. "It's
normal," everyone assures me. "You'll gain that confidence through
clinical experience over time." Well, as a third year acupuncture
student, I don't feel like it's been enough time. I walk into the
head clinician's office and start presenting the case. Something
just feels...off...with this patient.
The beauty of my internship at Stroger Hospital is that although
it's not set up to be an integrative treatment experience for each
patient, it can transform into one in under 60 seconds. Our calf
pain patient came into the acupuncture wing of the pain clinic, but
upon suspicion of an emergency situation (yes, we were all thinking
"Deep Vein Thrombosis" or "DVT" at this point in the show), we went
two doors down the hall and snagged an MD intern to evaluate her
presentation from a western perspective, too.
He quickly assessed her signs and symptoms and agreed that we
needed to rule out a DVT before moving ahead with her regularly
scheduled acupuncture treatment at that time. Within seconds, our
integrated team had changed course, explained the testing process
to the patient, called over to the ER, and had a nurse transport
For thousands of years the expansive Chinese empire developed
what we now call "Traditional Chinese Medicine," or "Oriental
Medicine," of which acupuncture and herbs form the foundation. A
complete and effective medical system, the doctors not only placed
needles, administered herbal formulas, gave hands-on manipulations,
moxibustion, and cupping treatments, but also did bone-setting and
any other emergency medicine that was required. Today, in the
United States, our scope of practice is generally not so extensive
as to include bone-setting, but we respect the completeness of the
TCM system in its entirety.
This does not mean, though, that we ignore the
advancements of other medical systems or technologies. It means
that instead of blindly accepting the often too-invasive and
side-effect ridden treatment plans of the mainstream western
medical system, we utilize only the elements that we see as truly
necessary or complementary to a holistic treatment plan. In short,
I LOVE DIAGNOSTIC IMAGING. Sure, it's wrong sometimes, giving false
positives and false negatives alike, but overall it gives us a
somewhat clearer look inside the human body than what we can piece
together by looking at a patient's tongue and feeling her
I'm not saying that modern diagnostic imaging is necessary for
an acupuncturist to be effective in treating modern patients, but
it is another tool in the shed nowadays. The shed has grown larger
in the past 50 years, but it's also full of a lot of junk. Often
the expert walks in, picks up the best tool for the job -- the one
he's trained to use most confidently -- and steps over the rest.
The skill is being adept in choosing those tools that are best
suited for the situation, even if they aren't from the same
"The doctor of the future will give no medication, but will
interest his patients in the care of the human frame, diet and in
the cause and prevention of disease." Thanks, Thomas A.
Edison. I like that quote. Doctors of Oriental Medicine,
herbalists, and acupuncturists generally give herbs as part of a
complete treatment plan, but giving a pill to pop -- whether
pharmaceutical, peppermint, or deer antler-- is not the only way to
The doctor of the future will be truly integrative. He will
skillfully diagnose the patient's whole body, mind, and spiritual
condition, drawing from both hands-on examination findings and
high-tech imaging of internal structures. In the future, when the
patient presents with the new chief complaint of acute calf pain
and swelling, we can use modern imaging to quickly rule out the DVT
and then use acupuncture to treat her condition and balance her
body. We can give her qi gong exercises and dietary changes to
support her long-term health and wellness. Thomas Edison will be
Further Reading: The Patient Will See You Now: The Future of
Medicine is in Your Hands by Eric Topol
I'm home. I know it, physically. I see my house, my car, and the
backpack already waiting to go back to class. But, my mind is still
in Nicaragua. This morning I subconsciously shook out my shoes
before putting them on. You know, to check for scorpions, since we
have so many here in Illinois. I tried to put my used toilet paper
into a basket in the bathroom at Target yesterday, and stopped
myself just in time. Go ahead and throw it right into the toilet,
Juli. Welcome home.
The week I spent volunteering at the integrative medicine clinic
in Nicaragua with Natural Doctors International (NDI) is sticking
with me for much longer. Even though it was my third time going,
pulling up to the rancho, strolling into the clinic, and meeting my
"mami" for the week was just as exciting as ever. The village of
Los Angeles on the island of Ometepe is a dry, dusty place at the
end of April, as the hungry families yearn for the rains to start
and signal the planting season.
The roughly 30,000 people strung around the base of the two
volcanos that form the island aren't starving, though. There aren't
clusters of orphaned children with protruding bellies scavenging
garbage piles with flies landing in their eyes. Even though
Nicaragua is the second poorest country in the Western Hemisphere
-- after Haiti -- life on the island is not what you might expect.
The children are mostly dressed, everyone has at least rice to make
in the outdoor kitchens, and villagers are seemingly low-key for
the most part, smiling, saying "Buenos Dias" as you walk down the
dirt roads punctuated only by horse poop and the never-ending small
Again, I'm awed by the graciousness of the people, who walk,
ride, hitch, or bike to NDI's free natural medicine clinic, and
then wait patiently and happily in the colorful plastic chairs out
back for hours. We learned that many of them give us a run-down of
five or ten general health complaints simply hoping to get a refill
on multivitamins, omegas, or probiotics, which they treat like gold
when we dump them into a plastic baggie for them. We delighted some
children with a new toothbrush to hold while Daddy hopped up onto
the table for some pain-relieving acupuncture.
We volunteers smiled as baby horses and cows causally strolled
around the village. After a few days we stopped asking, "Whose
horse is that?" when we realized that the animals knew where they
lived and ended up back at more or less the right house at the end
of the day. We struggled -- some of us more than others - to
communicate with our host families in Spanish about everything from
food preferences to how to refill the bucket for a shower. We even
celebrated a fellow volunteer's birthday with a birthday cake and a
huge bottle of Coke; the power only went out on us once.
Times were good. Patients were appreciative. Volunteers were
learning. We reminded ourselves how unique NDI's clinic really is
-- not just for Nicaragua -- but for anywhere in the world.
Mainstream western medicine is starting to shift, yes, but it's not
yet common in the U.S. to walk into a free clinic, have a consult
with a naturopathic doctor and receive supplements and a take-home
parasite-in-my-poo test kit, have a consult with an acupuncturist
and get needled under the mango trees, and enjoy a lavender oil
massage after a grievous counseling session with the in-house
psychologist. I've said it before and I'll say it again: Sign. Me.
Up. For. That. I even found the beach in our village this year,
after three years!
By day we performed the abovementioned magic out of the 3-room
open-air clinic. By night we grappled with the tough questions
during our evening classes on global health history and policy. Why
aren't we helping out in our own country? Why couldn't we carry in
all of the donations that we raised? Why are naturopathic doctors
not recognized in most states in the U.S.? Did they break ground
for the new canal? Why is smoke coming out of the volcano that our
village is ON!
Nothing is answered definitively; earthquakes rolled on days
after I left the island. I returned home to the pile of donations
that we couldn't get into Nicaragua. I still can't get my insurance
to cover a naturopathic doctor visit in Chicago. We didn't cure
every patient; the rancho still needs to be re-thatched before the
rains come; and the clinic ran out of children's multivitamins
before we even got on the ferry to head home. And it's OK. We are
fulfilled. Our work was done and cannot be undone. And guess what?
Hasta Luego doesn't mean "good-bye." It means "until next time."
Yep, I'll be back.
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
Between 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?
Then, 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
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.
Well, 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.
"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.
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.
Image source: www.visualphotos.com
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
Good luck, and happy hunting!
Yes, 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.
Some 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.
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.
The 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.
No, 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.
• So What Is Chinese Medicine?
• Jabbing Nerves with Needles
• Mission in Nicaragua
To read older blog posts, scroll to the bottom and click the "Older Posts" button.