NONE LEFT BEHIND

He came to the PTSD Clinic with a death sentence for his leg.  The VA docs said he would continue to lose function and gain pain from the gift of shrapnel stitched in his right thigh and groin from a landmine 30 years ago. Later he had rolled a jeep and crushed his shoulder.  For some fluke of fate he had gotten significant relief of that on a riverboat cruise in China, from a boat- bound acupuncturist who used a combination of bone-setting, needles and tuina massage to make it whole.  Hope from that is what drove him to my doorstep at the National teaching clinic.  One scalp needle got rid of the pain and restored function in minutes. His follow-up 2 days later confirmed he had gotten 75% improvement with that first salvo.  Treatment two focused on the shoulder with a needle through St 38 to Bl 57 points with similar results, followed by the 5 NADA ear points for the deeper, PTSD scars.  He, his wife, his farm (he sits on his tractor without pain) and his VA friends are thankful beneficiaries.  Happy July 4th ya'll. 

CRY ME A RIVER....

I have seen more patients cry at Cook County in the last 7 months than I have seen cry in 28 years of practice.  Take last Thursday.  I had a patient come in the week before for a first visit, and because she hadn't eaten yet (common instructions for the pain clinic) we went easy on her.  By that I  mean no heavy artillery.  No deep needling, strong stimulation, Northern style. Instead we put a few ear seeds on Shen Men, Zero, and her hip and leg points on the ear. She started crying tears of joy for the end of pain that she had been suffering since 1984.  She even went to church to share her story. But her mind got the best of her, suggesting it might in fact all be in her mind.  So she took off the seeds, and voila! Pain came back.  So she got a bobby pin and tried to press the points as she could remember them.  It helped a little.  After we put new seeds on her ear this Thursday. she was good to go.  We also showed her some Qi Gong exercises to extend her therapy, Energizer Bunny style.."Still Working!"

The second patient had a through and through gunshot wound to his right bicep, which immobilized his shoulder, and his hand, making him a candidate for surgery.  He also had tears tattooed on his cheekbones in memory of his fellow gang members who had been killed.  This was one serious dude. I told him that if I could get his shoulder to work, pain-free, it would probably restore his hand function as well. All it would take is a 5 inch needle going through the opposite leg, from Stomach 38 to Bladder 57.  He nodded. I did it. It worked.I wondered if their were tattoos for that.And would we both wear them?

Ear Ye, Ear Ye

In the early 50's several new patients of Dr. Phillip Nogier were coming into his office in France with similar burn marks on their ears. In each case they had been put there by a healer who had treated them successfully for back pain by cauterizing them along the helix of the ear. Taking note, Dr. Nogier went on to map out the rest of the ear, based on patient feed-back, in the shape of an upside-down fetus, and auricular therapy was born.  It is one of  the most powerful pain relieving tools in my acupuncture arsenal at Stroger Hospital. And many times I use ear-seeds for my first-time patients rather than needles, with equal effect.

To wit, Thursday I had a new patient present with low back and left leg pain at a 10 out of 10 level, not uncommon in my practice there.  She could barely walk, and when she sat on the chair in the treatment room she was curled up in a tortured knot of  torment.  She had not eaaten anything yet, and she was needle-phobic.  Not an uncommon presentation.  I expalined the value of having "fuel in her tank" to power up our therapy, which relies on moving her energy around her body to where she needs it.  Then I told her we were going to use the keypad of her ear to dirct the energy to the areas of pain, her back and left leg.  In the process she should feel some relief.

Reading her body language, I knew that she was more skeptical than hopeful, but also desperate.  I showed her the Chinese vacaria seeds mounted on little squares on tape that we use, and explained each point as I squeezed it in place on her left ear. Shenmen (Spiritgate) for stress; low back, and left leg points, I pinched each point hard and guided her fingers to them so that she could find them later, for at home relief.  Then I asked her to get up from the chair and start walking around the room. She gave me a look like I was crazy (much pain is memory of pain), but humored me. With each step her confidence grew more, and her pain grew less.  Until she was moving around the room relatively pain free, shaking her head that she couldn't believe it.

Over From ER....

 She came through ER over the weekend for acute back and leg pain, and admitted for tests and meds.  She was discharged on Monday, and back to ER on Thursday, without relief, asking to be guernied over to the pain clinic for acupuncture.   She was wheeled into the the clinic mid-morning, crying and white-knuckling, begging for relief.  The pain was rolling down her leg, from the hip to the toe, along the gall bladder meridian.  I went up to her right ear and placed tiny needles that barely fit between my ring-size eleven fingers into 4 points on her ear, shen men (spirit gate) hip, leg and brain stem, and watched her hyper down, like an air mattress deflating.  After a walk through of the 4 rooms manned by 4 acupuncture interns, I went back out and checked on our ER visitor.  She was dozing fitfully.  I reached down and pressed the gall bladder point in the hollow of her hip, and linked it up to the gall bladder point between his 4th and 5th toe, opening up the channel, and further reducing the pain.  About 45 minutes later transport returned, to wheel her back to ER, leaving all the needles, and most of the pain behind.

The ear is a remarkable energetic keypad to body function.  This was never more clear to me than when I visited a marine amputee at Bethesda Naval Hospital who was having trouble breathing.  When he lost his legs he lost half his kidney meridians.  In Chinese Medicine the Kidney Energy pulls down the breath.  That's demonstrated with the slap over the kidneys that kick-starts a newborn's breath. I put a needle in the kidney point on this marine's ear and which immediately reversed his hyperventilation, and visibly settles his spirit. I look forward to wider use of this remarkable therapy in ER. fy   

  

How 9 Bullets In The Trunk Can Turn You Into A Tree...

...and 4 needles in the head can restore flexibility and eliminate pain instantly.  I constantly work outside the comfort zone of belief, and history.  It happened again at Stroger the other week when I had a patient walk into the pain clinic carrying the fragments of 9 bullets in his chest.  About 23 years earlier I had seen Dr. Zhu use his style of scalp acupuncture on a wheel-chair bound victim of a "drive-by" and have him standing for the first time since he was shot (it always helps when you see what is possible first before you attempt to do it--replication, when done mindfully,  is usually much easier than creation).  When this patient comes back we will launch into the elegant and easy corrective exercises called Sotai, developed by Dr. Keizo Hashimoto, as well as continuing to use acupuncture to help him manage his pain, along with an orderly reduction of drug dependence, orchestrated by and coordinated with the M.D. side of the Pain Clinic.  I dreamed of this kind of collaboration following my first internship in Guan Zhao University of TCM Hospital in 1998, while still working as a Class 4 Felon Acupuncturist in Illinois. The gods grind exceedingly slow, and exceedingly fine.   

Stick out your tongue?

Most of our intakes at the Stroger County Hospital start with a simple request "Stick out your tongue please." After inspecting the tongue, and noting the color of the body and the coating, the shape, the sub-lingual veins, when then place 3 fingers on each wrist to determine the Chinese pulses for the Heart, Liver and Kidney on the left wrist and the Lung, Spleen and Kidney on the right wrist.  Since all of our patients are on multiple meds for pain, depression, and other issues, one might wonder how unsullied the information normally gleaned from tongue and pulse analysis are as indicators of what is happening, and not happening inside the body.  However, all else being equal, theoretically, with the addition of acupuncture and its potential to not merely reduce and in some cases eliminate pain and restore function though the mechanism of moving blood and bioenergy, these internal changes should also be reflected in the signposts of the tongue and pulses.  Were they not observed carefully by our Stroger interns (read the description of the Dali Lama's physician taking the pulse at Johns Hopkins in "Mortal Lessons" by Dr. Selzer) we would not be able to record if, when, and why those subtle yet profound changes had taken place. drfy

Every Tunnel Has A Bright Spot....

You just have to keep your eyes open.  That goes for patients and acupuncturists at Stroger County Hospital.  For practitioners, the crush of unresolved cases, back surgeries, neck surgeries, cancer, migraines, gunshot wounds, they bring not just their unmitigated pain, but its history, day after bone-crushing day.  It is a dark tunnel which encourages one to squeeze closed the eyes of the mind, and the soul, to gut through the next moment, hanging on for relief, no matter how short.

It's easy to buy into the story. I preach ruthless compassion.  Starting with self.  Cultivating the spirit of the Warrior..for Wellness.  It to build on the last post, "You can't give it if you don't have it."  And you don't have it if you are not building your strength, your prudent use of it, every day, with every conscious breath. We move into the painful space of our patients as fire-keepers.  We have the secret knowledge of seeing our work, no matter the circumstance, work more than not.  Without attachment to outcome.  We come into the room smiling, bright, hopeful.  We listen with our heart.  We cut through the story, and with a nickel's worth of needles, chase away the dragon of pain, at least for a while.  Expanding the circle of light. Which we nurture within ourselves, moment by moment.

Don't Get It....Don't Spread It!

Last week I introduced  another acupuncturist to the Pain Clinic at Stroger County Hospital.  He was impressed with both the overwhelming size of the facility in general, and the suite of 4 treatment rooms staffed by our NUHS interns on Wednesdays and Thursdays.  As we met after the tour, and I searched for a governing message to convey, one that might be different than the fundamental concerns which guide us at our Teaching Clinic, on campus.  In these instances it is always good to do a reality check, and look closely at who we serve, and how well we serve them. Two thoughts came to mind: 1) the section in the Stroger Orientation Manual that covers in detail the risks, and prevention protocols to contain cross contamination; and 2) the absolutely frightening book I read last year, The Rising Plague, after I was exposed to,  and treated my  first patient with confirmed mersa.  (I actually had a pregnant acupuncture intern who called me in on the case  initially refuse to assist, which to me was both a breach of her duties, and a lack of understanding about what we are routinely exposed to in our work).

Here's what I said..  More than a thorough, accurate intake, more than a proper and logical Differential Diagnosis, based on proper tongue and pulse diagnosis, and the 4 Examinations, more than an appropriate treatment strategy, including the selection of correct points and their accurate placement, more than proper bedside manner and good rapport with our Western Medicine Colleagues,  more than all these things, if any of our staff has either become infected with mersa, HIV, hepatitis, staph or strep, or any other transmittable disease, or passed it on to another, we have failed our mission. For truly care of self leads to care of others, and abuse of self leads to abuse of others. 

Bringing Threefers to Hospital Based Acupuncture

This week I experimented with sequencing and combining acupuncture protocols to deliver more impact in our treatments that last 40 minutes and because of demand, are repeated every one to two weeks or more.  If the pain was concentrated in one part of the body I would start by finding the points on the microsystem of the hand that corresponded to area on the body that was at a 8 to 10 pain level, and insert 5 needles in a surround the dragon configuration.  Then I would do Tui Na massage on the area, usually the neck, back, shoulder or hips.  I would then remove the hand needles and explain how they can stimulate those hand points themselves for relief between return visits.  Finally I would place an ear tacks on the part of the ear analogous to the part of the body that is in pain.  All patients treated with this new protocol sequence had 2 or more point reductions in pain.  Next week we'll find out how long their relief lasted. 

What has started with 2 interns and 12 patients on a Thursday from 7:30 to 3:30 in November at Stroger County Hospital ,has expanded to 4 interns and 40 patients on Thursdays and spread to a second, shift from 7 to 11 AM on Wednesdays.  Part of this expansion is from an influx of 10 to 15 new patients per shift.  Patients continue to teach us how to facilitate their healing (becoming whole) visit by visit.  We draw from a prodigious woodpile of  knowledge, accumulated over thousands of years,  to feed these flames fed by the desire to kindle the body's natural ability to heal itself.  .

I looked at the patient list early last Thursday morning, and the count was 51, with  15 being new.  However we got off to a slow start, which didn't help matters, Intake had a fill-in so we didn't actually see our first patient until 2 hours after our shift started.  What's great is we had some rally time where my 4 whiz kids and I had a chance to kibitz about fast-track protocols that could whammy one-sided pain.  The winner was the Korean 4 needle technique, where you identify the meridian the pain is going through, and on that side you sedate the Fire Point and tonify the Water Point.  On the opposite side you sedate the Water Point and tonify the Fire Point.  It was the flavor of the day for four patients, and knocked their pain down to zero in each case.  Three of them were first-timers.  That makes it a hard act to follow.

We got through our day, with most of our steady patients seeing continued improvement, and only 2 that we had to triage back to the Western Med side for an alternative to the acupuncture alternative.  One of the docs came down at the end of the day for a consult about an entrapped nerve from 4 broken ribs A nerve block didn't help any..  Two needles in the head put his pain in hiding.  But zinging the rib points on his left ear ( the side he did the damage too) and showing him the Sujee points on his left middle finger that he could self trigger really blew him away.  This week he comes back for a Tui Na Chinese Massage mauling, if he's game. If there are any pain remnants by the 3rd visit I threatened it with Plum Blossom Needle Hammer Therapy  Ouch..

Last Thursday's Pain Clinic Was Like Firewalking

Viewing that sea of hurt sitting in the Stroger Pain Clinic waiting room filled me with the same momentary anxiety as watching the "fire-tender starting to spread the coals across the 20 foot ember path I was about to walk across years ago( I think it's human nature to link our future fears with situations we have suffered through in the past).. It was the build up of preparation for the fire walking that stirred my apprehension to a peak, ratcheted even higher by having to pull my folding chair back even further from the edges of the coals that my friend Paul was raking out for us to walk barefoot on. My thought was, "If I have to move away from the coals now, what is it going to feel like when I'm standing on them."  Followed by, "And what if I fall on the coals."
To make matters worse, the cherry-red fire bed was surrounded by a collar of gravel, so that when I took my shoes and socks off, my tender feet were not prepared for the shock of the sharp stones that I had to walk over just to get to my starting point in front of the embers I was about to so bravely traverse.  But it turned out.  Just like seeing 50 patients, 15 of them new, last Thursday.

What helped ease my jitters tremendously was watching my 4 interns, Greer, Mary, Misty and Erica apply new techniques. like scalp acupuncture and auricular therapy which they had learned over the last few weeks.  Their confidence, and their skills are growing exponentially with each shift they serve  They are also getting sharper with their diagnostic abilities, thanks to keener assessments based on their reading the patients pulse, viewing their tongue, and asking them pertinent questions in order to construct a proper Differential Diagnosis. These cases are much more acute, much more critical, and much more complicated then the ones they are used to seeing at the University Clinic.  But then they too are learning to be fire walkers. 

Pain is like "a pig on ice".

I have Hoosier teacher, antique dealer Richard Oxenrider to thank for this expression. The double predicament of both chronic pain patients and pigs stuck on ice is that of those clutched in the dual dynamics of gravity and immobility. Trust me, I have seen it more than not. With pain patients, not pigs on ice. But I can imagine the later, spread-eagle d, panicking, the ice groaning beneath them threatening a cataclysmic crunch followed by a bone-chilling dunk. How to extricate the chronic pain patient from their predicament is the common question not well answered by either surgery or drugs, which tend to immobilize even more. Motivated movement toward the saving shore is the answer. Or as George W. said to his soldiers rowing him across the Delaware toward the encamped Hess ions, "Pray to God...and keep rowing toward shore."
So breaking the plane of inertia is important in both instances.

IMPACT:
What appears to be working more and more" first visit" at Stroger/Cook County Hospital Pain Clinic is Scalp Acupuncture. It seems to have the impact to shock those hardy enough to bear it in a direction away from the paralysis of pain. We (my interns and I) always have them move the offended area as soon as the first few needles are retained. I was taught to jump-start the treatment from the Middle Burner area, then go to the equivalent scalp somotope, usually the hip and back or neck and shoulder. Then get the patient mobilized immediately while gripped with the distracting pain in another part of their body. Sometimes my interns or I will add an opposing needle for stronger stimulation. (The jab and move, stimulus/response tactic is one I also saw my friend, Master John Howard also use with ASP Auricular Darts in his Battlefield Acupuncture Seminars.)

Follow-Through and Combination Punches
In boxing, follow-through and combinations add power to the attack. I learned this first-hand from Nappy, our Italian boxing coach at Notre Dame. The same seems to hold for stuck pigs and stuck"Energy and Blood" (the latter is the source of pain in Chinese Medicine). What this translates into during our weekly pain clinic shifts is making sure that patients have a combination of therapeutic activities they can do at home to support any movement they have made away from pain's grip, and toward more function. This can include teaching them Sujee Korean Hand Therapy, Sotai Corrective Exercises, and or Medical Qigong Movements to secure and reinforce any progress made away from pain and toward healing. This tactic of follow-through/combinations is, I believe, what keeps hospital-based acupuncturists from succumbing to the slippery slope of heroic vs. holistic therapy, designed to empower rather than enslave those in pain.

Putting Milk Back In The Cow

"Better to dig a well before you are thirsty...to forge weapons before battle." So says the ancient Chinese Medicine book, the Nei Jing. They are well past thirsty, our pain patients, and exhausted from battle. They come with years of scars dulled by drugs that have lost their edge. Now what? We start by beholding them differently. Three pulses each wrist, front, middle back, lungs and heart, spleen and liver, kidneys. What do they say? Fast, slow, superficial, deep, slippery, wirey. And the tongue, pale, purple, red? Thick or thin coat, white, yellow, black or none? They are wounded but hopeful. And sometimes progress is measured by teaspoons, or not at all. Sometimes there is a quantum leap forward from a handful of needles stuck well. And a slow return to before. Or not. No attachment to outcome. Just persistence. For Hope is Passion for the possibility. Of less pain, less drugs, no pain. No depression. Use come back, of a back, a shoulder, a knee, a hip. Slowly at first. Barely noticed. More by third parties than in the mirror. Rarely fast enough. The poser works on many things at once, plays the odds in the hope that one horse wins,places or shows. Not so the master. She locks on to the biggest gargoyle, takes him to the ground, and works her many holds, looking for submission. A frantic tap, sooner or later, signalling another round, with a lesser evil. We can't put milk back in the cow. But perhaps we can chill and stir it, and adding some flavor, serve up some ice cream.

Three new interns start at Stroger

Mary Thurmer, Misty Blomquist and Erica Perez joined Greer and I in treating 34 pain patients today. We have moved to scheduling 1st time patients for 1/2 hr. initial intake to establish the Pattern of Imbalance, with an automatic 1/2 hour, 6th visit review and re-evaluation. Another Dr. took advantage of our services for recalcitrant neck pain, which responded quickly from 4 to 0. Of our 7 new patients, one presented with blood sugar over 300,and terrible leg pain from dia etic neuropathy. Both lowered dramatically following Girdle Meridian Therapy. We are ramping up patient instruction in Qi Gong and Korean Hand Therapy as Carry Out Therapy to speed patient recovery.

No Pain Is Safe

Five of our 25 pain patients were new this week at Stroger Hospital's Acupuncture Pain Clinic. One had chronic migraines. One was a young woman 20 weeks pregnant with back pain so bad she needed a walker to steady her weak and throbbing right leg. 3 press tacks on her right ear shut down the pain immediately. The migraine will have to see the benefit of 6 needles between the toes and hot, mustard powder foot baths. Our Russian testicular and prostate pain patient skipped out with no pain after dermal needles were placed on the auricular prostate point, along with electro-stim on the Foot Shaoyin Meridian. And finally, a woman with stage 4 bone cancer, and excruciating rib pain that wrapped half around her body brought her friend and herself to tears from the total relief 4 dermal needles placed on auricular shenmen, liver, and rib points on the left ear provided. In time we will document changes to the autonomic nervous system with Heart Rate Variability monitoring before and after treatment for hard data in addition to patient feedback. We have doubled our NUHS interns from 2 to 4.

Carry-out Acucare comes to Cook

Our delivery menu of acu-therapies at Cook County's Stroger Hospital Pain Clinic is expanding. It started primarily with the use of needling body points,and where appropriate, adding electro-stimulation to key points. The next evolution was the employment of the Ear, Scalp and Hand micro-systems either on a stand-alone or auxiliary basis. This addition appeared to both accelerate the treatment's analgesic effect and in some cases reduce treatment time. There is another advantage, in that some of these Micro-system somatotopes can, with instruction, be self-stimulated by the patient, lengthening their salubrious effect. This expands the role of the acupuncturist even more in the area of teacher, as well as "treater". Moving even more progressively in this direction, modalities such as Medical Qigong and Sotai Corrective Exercises can be taught, complete with take-home handouts, to both enlist the patient in their participation in self-healing, as well as expanding both the scope and effect of natural therapeutics. Common herbal supplements can be added to the follow-on instructions. Such is the case with an acute prostatitis case where one point on the Liver Meridian mediated the pain to zero, and the proven over-the-counter herbal remedy combination of Saw Palmetto,Stinging Nettle, Pygium and Zinc was recommended. Evidence such as pain, urine flow, ease of urination and completeness of emptying will monitor effectiveness. With this shift in focus, with time spent having the patient employ carry-out therapies between shorter duration, in-clinic therapies, better outcomes are anticipated in terms of both rapidity and resolution of recoveries.

Carving an elephant

Once upon a time, in a land far far away, there was a famous artist who would carve elephants out of boulders. He would take his helpers down to the river, and walk along the shore, looking for boulders that would have elephants contained in them. He would then have his helpers drag them back to his studio, where he would work with his hammer and chisel. He explain that he was knocking "not elephant" off the boulder, to reveal the elephant. We do the same with the art of acupuncture.

Last Thursday a patient presented in acute pain. She was hyperventilating and screaming my name. She was having difficulty breathing, and near passing out. I attempted Lu 7, CV 22, and several ear points. She got worse. We got a wheel chair and transported her to ER. The first of the several hundred patients treated in the last several weeks with varying degrees of success, some extraordinary. It is good for our humility. We are facilitators. No more. And we are defined as much by our failures as our successes.

Exploring Microsystem Efficacy in treatment of pain

"Form follows Function"
With the doubling of intakes at the Cook County Hospital Pain Clinic last week,the use of more acupuncture modalities was explored, with the motive of discovering the advantages that the specific microsystemws of scalp and auricular acupuncture might have over macrosystem acupoints.

AURICULAR Acupuncture
3 patients were selected for minimally invasive auricular tberapy today who were 1st time patients, needle-phobic, or had eaten no breakfast. Pain reduction was comparable to or greater than macrosystem points.

Scalp Acupuncture
2 new patients with acute pain, who were open to tbe stronger stimulation and often more rapid pain reduction and function restoration afforded by scalp acupuncture, as well as 2 existing patient who had limited respnse to previous macrosystem point stimulation, received scalp acupuncture, with significant pain reduction, and in some cases, remarkable improvement in movement ability.