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.