Do the Du

One of the tough things about this blog is admitting that I've made mistakes. It's embarrassing, but I'm hoping you can learn from those mistakes.

Suppose you have a patient laying facedown on your table awaiting the miracle of acupuncture for their back pain. Suppose they have a lot of extra tissue. I'm not necessarily talking adipose; sometimes laying flat just pushes muscle/fat/skin backwards. 

Q: What's the first thing you do before placing a needle?

A: Find the spine/Du channel

Q: Where is their spine? How do you find it? 

A: PALPATE! Palpate all you like until you're satisfied. Get in there with your fingers and feel! Unless, of course, palpation causes pain. My advice then is to guestimate from mastoid process to mastoid process, from acromion to acromion and from ASIS to ASIS to the center. You can always scootch their pants down and look for the intergluteal cleft, too.

• Do not trust the point that their posterior hairline makes. 
• Do not trust their spinal fusion scar. 
• Do not trust the Yin/Yang tattoo between their shoulder blades. 
• Do not trust the tag on their underwear. 

Trust your fingers. That is all.

It's a great life if you don't weaken...

I used to think that starting up a small business would look like this:

Now I realize, just like the rest of life, running a small business looks like this:

http://www.lynierose.com/2013/11/expectation-vs-reality-of-your-life.html

A friend asked me how it was going the other day. I answered that I realize that owning your own business is like a log roll. Just keep walking. You have to keep walking. Keep walking and you won't fall off. 

http://www.theactivetimes.com/log-rolling-sport-future

So the question becomes, how do you keep walking? (and walking and walking and walking and walking...)

1. Believe in your dream
2. Have a strong will
3. Start out with the right business plan, the right business partner, the right legal, financial, accounting and marketing support!
4. Focus on what's going right, instead of what's going wrong
5. See the dips and valleys for what they are: dips and valleys
6. Take time to recharge yourself by way of meditation, exercise, acupuncture, massage, eating right, and taking time off every quarter!  
7. Be grateful for what you already have
8. Visualize what you want to have
9. If it's broken, take the time, heartache and energy to fix it now, don't wait
10. Put one foot in front of the other and don't stop

Cook times for Patients: They're Done When the Little Red Button Pops Out

When Less is More

I know that we were all taught in school that "Qi takes 20 minutes to circulate through the body". This has lead to the idea that everyone needs 20 minutes with the needles and then get them up and send them on their way. Many community acupuncturists (contrarians that they are!) leave people for as long as they don't need the chair for someone else, leading to two hour cook times. 

Some of my colleagues and I have noticed that, again, one size does NOT fit all. Many patients will do better with a shorter "cook" time. In my experience, those patients who have low blood sugar, are more frail, are elderly, those going through chemo and those who are fighting off external invasions generally do better with less time. Just like "it takes money to make money", it takes Qi to move Qi around. If you don't have much Qi to begin with, you don't want to go using it up by leaving someone too long with needles. 

One of my SWAC instructors taught that tonification must be done in many short bursts over a long period of treatment. This seemed counter-intuitive to me at the time, but now I get it. I, myself, have had several experiences of having acupuncture before lunch that left me wiped out. (This is an example of having your blood sugar too low for acupuncture.) I felt really relaxed, but also like I needed to go home and take a three hour nap. If your patient feels this tired after acupuncture, they have been over-treated. Next time use fewer needles or less time or both. 

Communication is Key

There are some people who don't fit any of these criteria who still do better with less time. One of my patients seemed like a very "excess" case at first: heat, phlegm, Qi stagnation. My inclination: sedate! Use lots of needles! One hour cook time! Said patient complained of feeling exhausted and foggy-headed. After working with this individual for a couple months, we narrowed it down to no more that 12 needles for no more than 2 minutes. Basically, I put the needles in, stand quietly for a moment, remove the needles, and my patient feels fantastic. I had another patient who said she felt like she was taking off in an airplane after just 15 minutes. It was an uncomfortable sensation for her. We shortened her time to 10 minutes and she felt relaxed and refreshed. 

On the flip side, I have had people ask me to leave them for a longer period of time. One of my patients told me he feels like he needs about an hour for his body to "hear the story the needles are telling". Folks who are more excess and those who take a while to calm down seem to do better with a longer time with the needles. 

Cook times can change, too. One of my regulars who tends to crash out for 45 minutes got very agitated 20 minutes into a treatment. He got angry, in fact. After I pulled the needles he calmed down and said that he just felt like "he needed to get up and go!" Patients who are more sensitive will learn to tune in to their bodies. The cues are different for everyone. Feeling antsy, suddenly awake, and energized are the ones I've encountered most often in clinic. 

Setting Expectations

I referred a friend of mine to a community clinic in another state. She's 80 and suffering from arthritis and fatigue. The acupuncturist told her to lay back and relax. The room was full of other patients when she received her treatment and she dosed off to sleep. When she came to, it was an hour and a half later and there was no patient or acupuncturist in sight. She began to get frightened and didn't know if she should call out. Had she been forgotten? When I heard this, I was upset for a number of reasons. First, you should always let your patient know what to expect. Second, (in my opinion) no acupuncturist has any business leaving an 80 year old with needles for that long! 

I let all my new patients know that I will come check on them in 30 minutes. After their first visit I let them know they are welcome to stay longer or shorter if they wish. I tell them I usually see people become deeply relaxed or doze off and then become wakeful for seemingly no reason. I think this is the body's way of saying: "Got the message, thanks! I'm done!" On average, I leave folks for 45 minutes, but I always let the patient tell me what's better for him or her. I never let anyone go longer than an hour and 15 minutes. Sometimes, I'll pull the needles out and let my patient continue their nap.

Wireless Doorbells

My thanks to Jen Alberti at South Shore Community acupuncture for pointing out the wonder of wireless doorbells. These little guys only cost a few dollars and can be picked up by a wireless receiver in your office or charting area. They are especially nice for patients that you have left facedown on a massage table. There's nothing worse than needing to use the restroom, feeling claustrophobic or realizing you need to pick your son up from daycare in 5 minutes when you're helpless and full of needles. At Left Hand, we leave one with almost every patient. That way they can ring us when they're done. If you're low tech, you can let your patients know that coughing repeatedly will bring you running. 

Hello again

It's been a long time and I feel guilty for not keeping up this blog as I had intended. Part of why I started writing it was I had things to share that I felt would benefit other people. I find myself having things that I want to share again. They say that life is what happens when you're making plans. It's also what happens when you're not writing blogs! So, welcome back.