A Room of My Own

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Always what I want to do immediately after I have been reading is to sit down and write.  By the last entry on my blog, you can tell how much time I’ve had for reading since moving back to Chicago.  This is, of course, an excuse, as the time has been there, I just have not chosen to fill it with books.  Although it’s a bit late, I’m adding “read one book a month” and “write one blog entry a month” to my list of New Year’s Resolutions.  What I’ve done this week is begin “The Night Circus” again, and this evening I got a few pages past where I’d gotten to when I began it the first time, many months ago.  But this time I have to finish it.

The book is entangled, and fun because the reader is omniscient—something I believe I would like to be until I realize, each time I think about it, that it would mean the end of mystery and the unknown in my life, a characteristic that I much prefer to “knowing all there is to know.”  It’s an interesting position, this place of having the big picture and still feeling empathy for the characters because they are confused by not knowing, and you can read their thoughts, remembering what it is like in your own life to not know.

Which leads me to think about predicting the future—and particularly at this stage in my life to consider what kinds of things I am bringing about by my words and actions previous to this point in time.

My husband is out of town this weekend.  I have been working such long hours and so many days—it feels like, although I cannot be entirely certain that this is true, I have not had a moment of reflection and rumination and peace for about a month now—that I stayed home.  We were going to go down and see some dear friends in Springfield for an annual party.  I love them both.  But I had a premonition that if I did not stop and rest then I would be sick—this is my habit, getting sick after every exam period of my life and as this is the first year in 41 years of life that I have not had big tests to study for around the holidays, it’s been a lot of cold-and-flu-like-symptoms—and I am too busy to be sick.  So I stayed home.

And what I wanted to talk with you about is the importance of solitude within a relationship.  It is not just that I stayed home.  It is that I stayed home alone.   This time is luscious.  It reminds me that I am an independent person—that I can navigate all those little duties and details that we normally share conjointly, that I am capable.  It also reminds me that I chose to be in this relationship every day, and am grateful for it as I don’t have to navigate alone.

This is the choice that my husband and I made to each other when we exchanged vows.  I am a big fan of Ranier Maria Rilke’s writings on love and marriage, and several of his pieces made it into our ceremony.  In essence, we vowed to watch over the solitude of the other person.  I always disliked the idea that “two shall become one.”  I like me as in individual.  I like him as an individual.  If two people meld into one person, there are no individuals anymore.  If you are melded into one being, where is the mystery?  If two are one, the relationship becomes predictable—each is omniscient about the other person—and there is no solitude.

What makes me happiest in my marriage is that there is still a sense that there are parts of him that I don’t know, still places to explore.  He takes trips and doesn’t tell me all the details at once upon returning, and then at dinner three months later will feed me a trinket of an experience he had while we were apart.   I appreciate those stories and the freshness of them.

The biggest boon to our relationship of this orientation is that we have room to wiggle.  I have switched careers.  He is writing a book.  I am exploring being a business owner.  He is an avid runner.  We don’t do those things together.  There is room to expand and contract and explore and return and…breathe. 

Perhaps I am just thinking about this because next week is Valentine’s Day. Perhaps it is simply because I love the moments of realizing that I still want him near me, next to me, beside me, keeping watch over my solitude as I watch over his.  Maybe it’s because it’s late and being pensive seems to come more easily at 3 AM than it does at 3 PM.  Perhaps because I am alone in this room, in this bed, and happy to be so and missing his warmth next to me at the same time: it’s because I have the luxury and peace of solitude.

(I originally intended to post this in February: fell asleep and forgot that I hadn’t posted it.  Forgive me.)

Extracting Earwigs

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I remember the first time I heard the term “earwig.”  It sounded to me like that horrible pincher-worm thing they put in the guy’s ear in that one Star Trek movie.  Gross.

Earwigs are something you can’t get out of your head, usually a song.  I have a friend who used to love to do this.  She would come up and purposefully plant an earwig in my brain by humming it while I was doing something mindless—usually while we were walking to class.

“Never gonna lift you up, never gonna let you down.  Never gonna run around and desert you…”

I wouldn’t even be aware of it until Rick Astley was so firmly entrenched that I was mindlessly humming or singing it for days.  (I hate Rick Astley, which is why she chose that song of course.)  It would often take purposefully coming up with a new song to “get it out.”  It went into my head very easily but metaphysical pliers were compulsory to extract it.

I’ve been thinking lately about the earwigs that we create for ourselves.  These are the little “tunes” that we dance to every chance we get.  They are almost always negative and yet we rehearse them over and over—as though our lives depended on them.  Ironically, our lives depend on getting rid of them.  If you want to really live, you have to quit listening to those little earwigs.

They say things like, “See! I knew you weren’t smart enough to get that done.”

“You’re so disorganized.  It’s a wonder you accomplish anything.”

“You can’t dance.”

“What were you thinking?”

“He is always going to be better/faster/richer/in better shape than you are.”

“You might as well give up.  There is no way you are going to get [whatever] done.”

It’s bad enough to have those lyrics floating around in our heads—on continual repeat.  But we also aren’t even aware that we’re humming those tunes.  On top of it we allow a chorus of them to chime in together and symphonically remind us how worthless we really are.  Each time we have the tiniest little setback or failure, even if that miniscule slip doesn’t really matter in the grand scheme of things, we use it to invite the earwig to hum in our ear again.  “See, I told you.”

The voice gains even more power by speaking to us as though it is outside of us, rather than a creature of our own creation and essentially indistinct from us.  It sounds like the lyrical equivalent of every authority figure you’ve had in your life, recapitulating small deficits as though it is necessary to catalog and reinforce your imperfections.  Talk about choking ourselves!  These earwigs are deadly.

I am not someone who has breakthroughs in yoga.  As much as I’d like it to be a spiritual practice, I have a hard time thinking about my inner being when my thighs are burning from 3 solid minutes of warrior one.  I am mostly thinking about killing the instructor, staying upright, how red my face is getting, and wondering why I put myself through this.  But this week in yoga, I was acutely aware of my primary earwig.

I was thinking about leaving Los Angeles and moving back to Chicago.  I was thinking about opening an acupuncture practice and teaching and having a new place to live and being around dear friends and all kinds of other happy thoughts.  Suddenly, I was worrying about the practice and teaching and friends because it means a whole new set of questions that I can’t answer and (and here’s the earwig part) it’s all been a charade since I don’t really know anything about medicine.

This discordant voice has been plucking away at my sense of intelligence for as long as I can remember.  My earwig says I am not smart enough—I’m not smart enough—I’m not smart enough—I’m not smart enough.  I don’t know where I first picked up this tune, but I know I had been singing it for as long as I can remember.  And in that moment I became intensely aware of it.

Then a tiny, tiny voice came up against that earwig and said, “I am smart.”  Such a small voice, but with such firm consonance with the core of my being.  In that moment, I knew it to be true.  I knew it with my whole self.  Utterly.  Completely.  I knew it, I became it, I am it.

And I knew that the earwig was just an earwig and not really a part of me.  That it had been lying all this time.  That the earwig was not honest, not true, and ultimately not even real.

I realized in that moment how completely I had allowed my being to resonate with that idea, that idea that I am not good enough, for years and years and years.  That I didn’t even realize how accommodating I was being to this jingle.   That I didn’t know I had been singing it over and over and over and over in my own ear.  That it had become a part of me, entrenched in my idea of myself, fused with my brainstem, intimately ensconced, manifesting itself in “see, I told you…”

And in that moment, I reached in and plucked out the earwig.  It was shockingly simple.

Work on extracting your own earwigs.  Become aware of singing their seductive song.  Then stop.  Find a new aria to sing.   One that’s true.

The moment I was fully aware of its presence, the earwig was gone.  It has not been there since.  I, unfortunately, cannot say the same for Rick Astley.

What You Don’t Know You Don’t Know

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I don’t like to be preachy, but it bugs the everloving crap-ola out of me when people throw comments out there that are completely irrational and obviously untrue. This kind of thing tends to be followed with assertions that the [insert evil body of power here] is involved in a plot to undermine [insert way of life, liberties, food sources, etc. here].  I agree completely that there are dysfunctional and manipulative evil bodies of power out there.  All I’m asking is that you vet your information before you start pointing the finger.  The impetus for today’s blog is:

“It’s a real shame, there is a huge rise in Shingles and PHN as a result of the chicken pox vaccine. Since children aren’t getting the disease anymore, it’s striking adults in the form of shingles as hosts.

http://articles.mercola.com/sites/articles/archive/2010/11/02/chicken-pox-vaccine-creates-shingles-epidemic.aspx

Has anyone else noticed this epidemic in their practice?”

<sigh>

What makes me most sad about this assertion is that the author probably believes it is true.  She read that article, knowing what she knows.  But she didn’t think about what she doesn’t know that she doesn’t know: she therefore couldn’t think about the implications or assertions of the article critically.  Even worse, she passed along the information as though it is true.

I think that most people in the healthcare industry are interested in helping others.  You wouldn’t put up with all the hurdles and logistics and pain of training if you weren’t on some level an idealist.  (If you’re smart and more interested in making money, you go into tech or marketing–I just don’t buy that doctors go into the field for the $.  There are too many other options that are easier ways to get rich.  But that is another post.)  What I want to talk about today is that one of the most difficult issues with being a healthcare provider is the information that we don’t know we don’t know.

There are a lot of things that I know that I know: how to drive a car, for example.  There are a lot of things that I know that I don’t know: how to drive a rocket ship to the moon.

In medicine in particular, it seems to me that things get more and more and more complex.  Going to graduate school and doing research on a subtype of 1 receptor involved in angiogenesis taught me that: I learned about it for over 2 years and still felt like I was scratching the surface.

We cannot possibly be aware of all that we don’t know we don’t know.  This situation becomes, in my opinion, the source of malpractice— which I believe is mostly unintentional.  I don’t know of any doctor, acupuncturist, chiropractor, etc. who said on their application “I want to hurt people.”  The problem, at least in part, is in limiting the scope of one’s knowledge and disseminating information based only on what you know that you know.  Unless we look it up, we will not learn.  If we don’t learn, we get behind very quickly and then we pass out information to patients that is, frankly, incorrect and often hurtful.  If we further base our care on that information, this is malpractice—causing harm to patients.  The law (and my patients) doesn’t care when I graduated from medical school: it is part of my job description to keep up.  Beyond what the law says, I feel that it is my moral and ethical obligation to double-check what I am doing.  It is hubris to think that I know what I know simply because I learned about it 10 years ago.  I want to learn about my blind side: what I don’t know that I don’t know.

So in an effort to try to explain herpes viruses, epidemics, and basic immunology, I constructed this response.  Perhaps others will find it helpful.  Maybe someone will correct me and show me what I don’t know that I don’t know.  I welcome it.  I’m still learning.

(By all means continue reading if you’re interested, but this is the immunology part and you might not be so into it.)

Varicella zoster virus (VZV,), one of the herpetic viruses and the virus that causes BOTH chicken pox and shingles, works like this.  After it has caused chicken pox, it gets into the dorsal root ganglion (collection of nerve cell bodies) of the spinal cord and resides there dormant.  When it is activated, usually by stress, it will irritate the nerves in that ganglion: first it causes burning pain along the dermatome served by that ganglion, and then the characteristic herpetic lesions appear on the skin.  Post-herpetic neuralgia is very concerning–and can be quite debilitating–because the nerves from that ganglion(s) can become permanently irritated, resulting in chronic pain.  Remember that the dorsal root is the sensory root: this is why patients have pain as a symptom rather than motor dysfunction and why the pain is most commonly along a cutaneous distribution rather than at a deeper level.

The article you are citing makes it sound as though NOT getting chicken pox increases your chances of getting shingles.  Actually, GETTING chicken pox is a SURE way to increase your chances of getting shingles.  The body cannot clear VZV: in EVERYONE the virus resides in the dorsal root ganglion.  So if you had chicken pox as a child, you have the virus already in your system with the potential to develop shingles.  If you have received a vaccine, you have acquired immunity (more on this below) to the VZV without the risk of shingles because you are able to preemptively ward off an attack of active VZV when exposed.

The fact that herpetic viruses are difficult/impossible for the body to clear is demonstrated in most, if not all, of the herpetic viruses (recent literature is demonstrating, for example, that herpes viruses may be a significant part of the etiology of Alzheimer’s–they are finding clusters of herpes in the areas of the beta amyloid plaques).  You get cold sores over and over again, you get genital outbreaks over and over again, etc. because the body cannot clear herpes viruses.  Viruses, by definition, live inside of other cells: they depend on cell mechanisms in order to replicate.  Herpes viruses infect nerves, and the immune system is less adept at attacking the nerves in the spinal cord because it has the added issue of getting into the blood brain barrier.  Further, the cells that are best suited to deal with viruses, the T killer or cytotoxic T cells, would be commanding the infected nerve cells to commit apoptosis (cell suicide).  This would lead to permanent nerve damage: nerves are not able to repair themselves the way that other tissues can.  When they are cut, sometimes they can reconstruct their “pathway” to the target tissues by following the sheath that formerly surrounded their axon, but when they are told to commit apoptosis, the entire cell, including the soma/cell “brain” dies.  There is nothing left to follow the neurolemmic sheath.  But I digress…

An epidemic is a situation in which the numbers (incidence) of a disease exceed expectations in a given period of time and in a particular population.  Right now, nearly 1 in 3 adults will get shingles at some point in their lifetime.  I am not sure how you arrived at the conclusion that this is an epidemic as these numbers have actually decreased in younger populations since the vaccine was introduced in 1995.

The vaccine was constructed not only as a way to prevent the severe cases of chicken pox from killing children–granted this is a minority, but it’s 100% for you if your child happens to be in that category and 100 out of 158,000 is not insignificant–but even more to prevent shingles and PHN.  Since about 1 million people each year will get shingles, it doesn’t seem to me that this was an irrational reason to develop a vaccine.  Merck is a drug company, yes.  Drug companies do try to make money on drugs, yes.  But it is not reasonable or accurate to say that Merck “created” this issue any more than Salk created polio.

Additionally, the article you cite states that vaccines provide only temporary immunity.  This is patently false.  Anytime you stimulate the adaptive immune system, T and B cells give you lifelong immunity.  I’m not sure how the author thinks that establishing immunity happens, but the lab tests are based on looking for antigen-antibody interactions: you can’t have antibody-antigen interactions without stimulating the cells that make antibodies: the B cells.  This absolutely means that the adaptive immune system has been stimulated.

We get booster vaccinations, like tetanus for example, because the immune system needs “reminders” to keep the levels of B and T cells HIGH in the system: the B and T cells are still there.  They just need reminders to remain on higher alert—kind of like the “code orange” alert level in the airport.  When we are chronically exposed to something, staph or strep for example, the body is constantly being stimulated to keep titers of B and T cells elevated to fight those infections.  In the cases of pathogens that we see less frequently, the body does not waste energy maintaining a high number of those B and T cells.  So statistically speaking, it is less likely that the antigen (the key) would interact in a meaningful way with the B or T cell designed to fit it (the lock).

The links in the article you cite actually link back to the same page and/or author in several instances.  To me, this is not citation.

Here are some articles that are vetted and contain reliable information if you are interested.

http://www.cdc.gov/shingles/about/overview.html

http://www.uptodate.com/contents/prevention-of-varicella-zoster-virus-infection-chickenpox?source=preview&anchor=H17#H17

All the best to you and your patient and I hope that this has been helpful.

My Action Verbs

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A friend of mine recently told me about an exercise he was doing at a conference.  He was asked to come up with an action verb that described him–more than described actually–one that defined him.  He said they were asked to put it into the phrase, “I ______, therefore I am.”  The participants then had to put their verb/sentence on their name tag.  There were lots of “create,” “innovate,” “dream,” and “lead” people in the room.

My first instinct was to pick “learn” as my action verb.  He argued that “teach” might be more apropos for me, but I think if I had to pick between them, I would ultimately cull out learning over teaching: “learn” has to be my verb.  At 40, I have yet to not be a student (with the exception of one 6 month stint and one 15 month stint I have been enrolled in school in some form for all but the first 3 years of my life).  But I have only been a teacher since I was 16, when I first began coaching gymnastics.  I think too that the process of teaching always teaches you something, and I am constantly learning from my students.  “Learn” it is then.

A close third, however, to this educational debacle is “I cook, therefore I am.”  The eating part is gratifying too, but again, given the option, I’d pick cooking over eating every time.  When I left surgical residency, the choice to stay in medicine rather than go to chef school was formidable but ultimately decided by my rather severe shellfish allergies.  I couldn’t be sure I wouldn’t be required to make a lobster bisque or something and end up in the hospital breathing through a tube.  Surgery and culinary school are pretty similar in my mind: get to play with sharp knives and fresh flesh, have to combine standard “rules” for doing things with non-standard artistic modes of putting people/food (not the same as “people-food” mind you!) back together again, when things to not go as planned it is time to go back to the beginning and triage what went wrong, etc, etc.  Being a chef after being a surgeon seemed like a reasonable transmogification.  Acupuncture, which I ultimately chose, is also similar: sharp needles, familiarity with anatomy, constantly reassessing how to improve the patient’s treatment strategy, etc.  I guess I have a fascination with sharp pointy cutting implements–I’ll have to watch “American Psycho” again with the hubby to make sure there are no early warning signs.

The point is that I love to cook.  I mean I really love-love it.  Food makes people happy and brings them together in a way that no other social activity does.  I like the “togetherness” of food: the bonding that sharing the experience of a meal brings.  Knowing that I’m creating that sort of environment for people I love makes me delight in constructing a menu to please both my own palate and theirs.  I like the challenge of people with dietary restrictions too; trying to alter recipes for various allergies, preferences, or intolerances is a fun game for me.

I love the chance to try new things–to get people’s reactions and feedback–but even more I love to bring out past favorites and see the delight and anticipation on people’s faces.  “Remember that soup from last time…”

I also love to pick one or two spices and try to create a meal based on that one flavor–what will blend with it, what will contrast, what will complement?  What textures or temperatures can I tweak to bring it out?

Cooking is, for me, a way of expressing my “joie de vivre” and love of my friends and family.

I’ve recently started following a few other bloggers who post, virtually every day, spectacular images of gorgeous food they’ve created.  In a few months I’m going to be in a new kitchen…and I’m going to start doing that.  Maybe not so much as Julie a la “Julie and Julia,” but I’m going to start.

Collaboration, not competition

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This morning began with an innocuous-enough message through Facebook.  “Hi Leslie. Wow, I didn’t know you graduated from [acupuncture school] so quickly and got through the boards and passed all the tests to be an acupuncturist/Chinese herbalist. What’s your secret?”

I began explaining how I have to practice under my MD and therefore didn’t finish all the training to be an LAc: it would just mean jumping through hoops and paying a lot of money and, in the end, I would still have to practice acupuncture as an MD because it is my terminal degree.

It turned out, during the conversation, that the person was not really interested in the answer to her initial question.  She was primarily interested in understanding how physicians become acupuncturists and how she could protect her position as a future LAc in a complex medical system largely dominated by biomedicine and western approaches to healthcare.  I realized that this may be a common concern and decided to write a post about it.

Most physicians have minimal, if any, exposure to complementary and alternative medical therapies in medical school.  (You must understand I am talking in broad strokes here and there will, of course, be exceptions.)  As far as I can remember, I had none.  Some of you are already shaking your heads, but what I mean is that I had no negative or positive discussions about it.  It simply wasn’t part of the curriculum.  I was going to medical school to be an MD and that was what was being taught.  I also credit my medical educators for not talking down about other healthcare practitioners, or even talking about them at all.  It wasn’t until I was in residency–and seeing some of the results of overly-aggressive spinal manipulation that resulted in paralysis–that I heard someone say something negative about chiropractors and even that was in the context of “chiropractors do a lot of good, but this is horrendous.”  There was acknowledgement of the other therapy, but dismay at the damage that had been done: a completely appropriate and respectful response, in my opinion.  Words like “quack,” “no scientific basis,” or “voodoo” were not used–no words were used.  It simply wasn’t discussed.

This is in sharp contrast to my experience in acupuncture school.  Before people knew I was a physician, I heard over and over and over again reproachful and vengeful comments about biomedicine: the evils of doctors, how western physicians don’t ever care at all about their patients and never listen to them, how doctors are in collaboration with insurance companies, drug companies, etc. to screw over patients.  Interestingly, when people learned of my background, the comments didn’t stop.  They were just prefaced by “I know you’re a doctor and all, but….”  I don’t mean to discount the experiences that lead my TCM colleagues to pursue acupuncture training, but making statements (and even more behaving as through) all physicians are evil is as ludicrous as saying that all ducks are brown.  Aside from being obviously untrue, it’s just silly, unprofessional, and shortsighted.

It reminds me of the rivalry between Los Angeles and San Francisco.  SF considers LA to be a huge rival and when I am with people from SF they are often comparing LA to SF in some sort of unfavorable light.  I have never heard a disparaging remark from someone in LA about SF.  Angelenos seem largely unaware of this “rivalry.  Likewise physicians are dismissive (at worst) or curious and pursuing more training (at best) with regard to acupuncture.  They certainly don’t consider acupuncturists to be rivals and many are looking for acupuncturists to collaborate with and refer patients to.  By contrast, acupuncturist forums are riddled with comments about doctors mistreating their patients in one way or another.

I didn’t know I was supposed to be competing with acupuncturists for patients or for any other reason.  Frankly, the thought of it breaks my heart.

You might also want to be aware of interesting differences in training requirements.  There are about 14,000 acupuncturists in the United States: this is a very favorable practitioner to patient ratio.  Only 43 states require acupuncture boards prior to practicing (National Certification Commission for Acupuncture and Oriental Medicine nccaom.org). Some acupuncturists are eligible to sit for their boards without going to school at all: they “intern” with an experienced acupuncturist and then take their exams when certain requirements are met.

By contrast, all physicians must attend at least 4 years of medical school (after obtaining a Bachelor’s degree), and pass a series of 3 licensing exams in order to practice medicine.  Most complete 3-10 years of additional training (called “residency,” during which time they specialize in one area of medicine or another) to become board eligible and after passing boards (written only or a combination of written and oral) are considered “board certified.”  The requirements for a physician to practice acupuncture vary from state to state.  Some states require no additional training; others mandate the completion of at least 300 hours of continuing medical education.

While 300 hours does not sound like much to those of you completing 3000 hours of acupuncture training, consider the following.  I am currently enrolled in one of these courses, learning Japanese-style acupuncture on top of what I learned in TCM school.  This weekend, in under 10 hours, we learned all of auricular acupuncture.  I mean all of it.  We learned the anatomy of the ear (something that no one really focuses on unless you specialize in Ear, Nose and Throat surgery and therefore must be taught to doctors), the entire homunculus, the internal organs, the special points–all of it.  That same class I took in acupuncture school for 30 hours: 15 weeks x 2 hours per week.  There seems to be a common misconception that hours are equal at different kinds of schools.  Medical school was not so long ago and I remember the pace being 3 to 4 times faster than in acupuncture school.  So that means that physicians are getting AT LEAST as much training in acupuncture, if not more, than their TCM-educated colleagues because doctors are learning in 1 hour what TCM teaches in 3-4.  Further, the physician acupuncture courses focus only on acupuncture.  There is no herbology or Tui Na or anything else.  Just acupuncture.

I’m not trying to denegrade the training I received in TCM school, just to explain that physicians are also well-trained in acupuncture by the time they finish one of these courses.  But the training is different.

What I really wanted to hightlight, though, is that I see myself (and my acupuncture-trained physician colleagues) not as a replacement for a TCM-trained practitioner, but as an ambassador for acupuncture specifically and alternative medicine in general.  While this may not be true in California, in much of the country, acupuncture is regarded with a raised eyebrow.  This country values scientific proof, and the fact of the matter is that acupuncture is extraordinarily difficult to “prove.”  (See my previous post on the subject.)  As a physician practicing acupuncture, my MD aids in an LAc’s credentials.  Because I have chosen to focus only on acupuncture and herbs, leaving behind my surgical training, my physician colleagues have become curious about TCM.  When they ask me about it, I am able to share this medicine with them, and because they trust me, they trust the medicine.  Pure and simple.  I have referred family and friends all over the country (in the last week, in Florida, Phoenix, and Boston alone) to acupuncturists.  They will “try it” because I am sending them to you: because I trust acupuncture over the biomedical alternatives, because of my biomedical background, because of my credentials.  I am an excellent marketing strategy for you.  I am helping you.  I am furthering the cause of this truly preventative mode of improving the lives of people, and I am doing it in a collaborative manner.  I am not your enemy.

The Problems with Acupuncture Research

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I was inspired today by an article discussing the use of acupuncture to help couples conceive.  I’ve been reading a lot of primary literature lately on acupuncture research and wanted to share my thoughts.

One of the biggest problems with acupuncture research is that TCM treats patients as individuals.  It is impossible to set up randomized controlled trials when one person is unique from another.  One of the best structures I’ve seen is the comparison of sham acupuncture during a waiting period to that of the same cohort receiving verum acupuncture at a later date.  However, waiting—particularly when studying pain—is also problematic as many pains change over time.

Further, attempts to compare studies and coalesce them into a larger analytic structure (called a “meta-analysis”) are virtually impossible because of the different modes for controlling the study.  If one group is controlling by sham acupuncture and another using verum acupuncture at sites not known to treat the condition being studied, and another comparing treatment to “standard of care” only, it is highly suspect to lump them together and make conclusive arguments.

Finally, the acupuncture points can be used for widely varying uses, depending on the style one is employing.  That is both the elegance and the difficulty of using energetic manipulation to help the body heal: when the dots are connected in one way, they tell the body to do one thing.  When they are connected another way, they give a different road map.  I think of the points like intersections on a map.  When you come to the energetic intersection at point Spleen 9, you can turn toward the metaphorical southeastern corner if you want to treat “Dampness” or direct flow toward the northwest if you want to decrease pain at the great toe.  Knowing all of these uses empowers me as a practitioner to pick the best modality for the needs of my patients in the moment, but it makes Japanese, Korean, and Chinese styles of acupuncture very difficult to compare.

I am becoming increasingly interested in helping the acupuncture research community to establish a means of controlling studies.  Only when we can demonstrate that we can group patients in some way and compare them to another cohort, will we win the respect of biomedical practitioners.  Until then, acupuncture will remain a “belief system” instead of being seen as the powerful and potent modality that it is.

On learning about the Internets

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It is now 3:44 AM.  I have been at my computer for the past 5 1/2 hours trying to figure this stuff out.  I’ve been reading about it for over a week on one of the discussion groups I belong to on Linked-In, but was too intimidated to do anything about it.  Thank goodness that the hubby is training for a half-marathon and was wiped out by 9:00 this evening.  He went to bed early, and it forced me to figure this out for myself.

 

Honestly, I am a bigger fan of computers here recently than I ever was in the past.  For years I clung to my yellow pages (it has coupons that I might NEED someday!), and M and I would race to see who could find the pizza place’s number faster: him on the new hotness, and me on the old and busted.  For the longest time it was about 50:50.  But then we got a cable modem, and everything changed.  It wasn’t even close so I eventually had to admit defeat and recycle 5 years worth of phone books—and all of those expired coupons.

 

I feel pretty good about finding stuff on the internet now.  It’s just all that other web stuff that I’m not so good at.  Like blogging consistently, for example.

 

My practice has been open for a few months, and I am, thankfully, getting busy enough that I feel like I need an online scheduler.  It didn’t occur to me to ask someone else about what they use in a forum (aren’t chat rooms for porn?), so I’d been reading about the different ones by doing what I do best: using Google to troll endlessly for sites and then spending hours trying to compare and contrast which one is best (not necessarily best for me, just best period).  (I’m anal like that.)

 

Thankfully M pushed me to get on Linked-In about 4 months ago, and I have since discovered all the interest groups on there.  Innocently, I joined about 50 million of them.  Little did I anticipate that the people in those groups are actually talking with each other: asking for help or advice or sharing information and ideas.  Most excellent—but makes for a lot of email.  A colleague asked for advice on using online schedulers in one of these forums, and I was floored when people actually took the time to answer her.  Even more excellent.  That email felt a lot less spammy.

 

So armed with these new insights, I proceeded to actually pick one and brave the scariness of signing up, filling out all the forms, constructing my schedule, giving myself “time off” when I have to be out of town, and… then it was time to integrate it with my website <shudder> so that people can actually use the damn thing.

 

I am eternally grateful to the Great Powers of the Universe that they gave me a baby brother when I was the ripe old age of 12.  The bonus baby is up on all this web-based stuff and has been building my website and educating his only-slightly-older-but-spoiled-by-her-internet-guru-husband sister about everything from photography to UNC basketball via the web.  He’s really quite clever.  This is not to say that I’m not or that I’m even particularly ancient or incapable of learning new tricks, just that there are some things that I am not interested in learning about in which case it is quite difficult to learn about them.  HTML is one of them.  And all of those other modes of communicating with a computer through the gobbledy gook of colons and backslashes are another.  I simply don’t care.  If I can’t cut and paste it, it’s not going to happen.  You may have already guessed that I have a Mac (again at the suggestion of M who, in retrospect, was probably just tired of the tech support calls in the middle of his VeryImportantMeetings and therefore insisted that I learn to use a computer where closing a document on the wrong side and the up-down arrows are oddly close together and there is no Start button so how do you search for things again?): I just want it to work the way that it should and when it doesn’t I am a)confused and b)put-out about it.

 

But I am getting side tracked.

 

So Z has been building my site and M is my own personal tech support army so I don’t really need to know how to do any of this on my own.  Except that I am impatient.  This is my undoing.  Tonight I decided that this is THE night for getting all of this squared away and I’m just going to have to figure it out…on my own all by my lonesome.  So I took a deep breath and plunged.

 

And I have to say, it wasn’t so bad.  I had a momentary moment of grumbling about losing a whole page worth of text when I hit a button that gave me an error and erased 30 minutes of work.  In that moment I immediately clawed at the site searching for any form of tech support, but who am I kidding at 2 in the morning?  No one is awake in the world except me (and the upstairs neighbor who strangely listens to the TV VERY LOUDLY all night long), and so no one sprang to my rescue.

 

After the grumbling, I got smart and retyped things in Word and then cut and pasted them.  (Yay!  Cut and paste!)  Of course, this time I got no error message.  I swear the web knows when you are prepared to be thwarted and have taken precautions and when you aren’t and haven’t.  And this brings us full circle to the scary integrating into the website issue.

 

Which, as it turns out, wasn’t so bad or so hard.  I clicked around and figured it out.  Nothing exploded, including my little pea brain.  Go figure.

TheBestDogEver gets a new diet

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I keep meaning to start up this blog, but it seems slow going.  Best, I suppose, to just start.

I want to talk about the transitions I’ve been making, and about cooking and food, and about places I’ve been.  But today I want to talk about Grace, my dog.

She’s a mutt, a rescue.  We’ve had her since 2004 and think she’s about 7 1/2 years old.  She has been dubbed TheBestDogEver by anyone who has ever met her.  Grace had horrible mange when she was a puppy, and being the runt of the litter, she is eager to please and smart enough to be able to figure out how to do that.  We suspect that she was never petted before we got her and makes up for it every chance she gets: she will stand for hours while you rub her belly or scratch her neck.  She just can’t get enough.

Six months ago she was beginning to limp.  I noticed it mostly when I was walking her outside–even more when she would try to go up and down the stairs leading to our apartment building.  But I couldn’t tell which side she was favoring.

When I took her for radiographs, the vet commented that she would not have expected Grace to be able to walk at all if she had seen the X rays first.  She expected Grace to need surgery, bilateral hip replacements, within 6-9 months.  While it was a relief that the diagnosis was not an osteosarcoma in her hip or pelvis, this was not also welcomed.

The vet recommended some supplements.   I looked at her like she was crazy.  I don’t take even a vitamin on a daily basis: you want me to feed Vitamin E and Omega 3’s and chondritin sulfate to my dog?

But Grace is the BestDogEver and so I went to the Vitamin Shop and stocked up on supplements.  The vet also recommended a homeopathic pain remedy (really?) called Traumeel.  Bought that too.  And the Pill Pockets needed to get her to take all these pills.

Lastly the vet recommended changing her diet.  Now this was too much.  We feed our dogs “high quality” dog food–a combination of wet and dry–and they snarf it up indicating that they must love and prefer this above all other kinds of food, right?  Grace used to not be interested in food at all–we would just leave it out for her all the time and she would eat when she got hungry–but after we switched to this more expensive brand she goes crazy for it.

But I’ve seen what patients go through when they have a hip replacement–inside and out–and I don’t want Grace to have to go through with that.  So I began cooking for the dogs.

Finding recipes online for dog food is easier that I thought it would be.  I started with rice, raw hamburger, and sauteed carrots.  They wouldn’t eat the carrots.  The next day I added a little raw egg to hide the texture of the carrots.  They gobbled it up.

I read that oats and sweet potatoes are good for joint disorders.  So I added them to the mixture.

I had a breakthrough when I began looking at the ingredients on the back of the cans I kept around (just in case I don’t have time to make food for humans or dogs) and using those foods to make dog food.  I also started making large batches on the weekend–making it easier to just heat up a little portion during the week.  I grate apples and carrots and potatoes into a pot, boil it in minimal amounts of water until all the veggies are soft, then add some green beans or cranberries.  As it’s cooling, I add some quick oats or quinoa.  I make a layer of the starches/veggie mix and then a layer of meat (raw ground beef, cooked chicken, organ meats–whatever was on sale at the grocery store).  This is now their wet dog food.

Grace started getting better.

I took her for acupuncture once a week and added herbs (as in Chinese medicinal herbs) to her diet.  I know this is crazy to say, but I swear she started smiling more.  And she was limping much less.  She no longer had to bunny-hop up the stairs but was climbing again alternating her hind legs.

We added some doggie vitamins made from ground up liver and that sort of thing.  Her coat glistens.  Her energy improved.  She wants to play and romp around the house again.

It has been 5 months now and I would say there is no indication that this doggie has hip dysplasia.  She goes on hikes with a dog walker twice a week, and he says she runs and plays with the other dogs the whole time.  She  can stand again on her rear paws to get a treat and bounds in and out of my car.

I think this is an amazing testament to the power of what we put into our bodies.  I don’t know if I caused damage to my dog by not feeding her better food in the beginning, but I am certain that I was able to reverse the damage and the pain she was in by changing her diet and providing her with the nutritional supplements she needed to get heal.

My background is strongly biomedicine-based: if you can’t prove it with a randomized controlled trial, it isn’t proven.  But I have to say that this experience, among others I’ve had in the past 2 years, has really opened my eyes to the power of nutrition.  It has caused me to look at everything that I put into my mouth in a new way.

Thank you, sweet Grace, for being my teacher.