Archive for tag: stroger

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.


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 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 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 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.


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.


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.


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

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.

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.


"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.

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....