Archive for tag: patients

Acupuncture or ER?

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.

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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.

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"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 pocket.

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.

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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.

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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 the patient.

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.

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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 pulses.

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 pile.

"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 help.

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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 proud.

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Further Reading: The Patient Will See You Now: The Future of Medicine is in Your Hands by Eric Topol

Hasta Luego, Nicaragua

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.

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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.

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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 fires.

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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.

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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.

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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!

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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!

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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.

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.

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.

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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!

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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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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 similar style.

Good luck, and happy hunting!

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.