I had a phone inquiry the other day when I got into the office.  The message said “I want to know more information, please call me back at 818.xxx.xxxx”.  No name, no other info.  So I returned the call and, after some explanations, got through to the person with the question.

 She wanted to know what services I offer.  I explained to her that I practice Traditional Oriental Medicine, which means I combine needles, herbs, dietary advice, exercise and other treatments, as appropriate, on a case-by-case basis.  I then told her that, in general, my patients all receive acupuncture and most of them opt for herbal formulae as an adjunct.

 She asked me about fees, and I countered by asking if she was coming in as a cash or insurance patient.  She said her insurance wouldn’t cover acupuncture, so I told her that acupuncture was $190 for the first visit, $85 thereafter and the herbs were usually between $5 and $10 per bottle and that a bottle tends to last for two weeks to a month.  I also explained that if she needed acupuncture with electrical stimulation the fees are $200 for the first visit and $95 thereafter.  I also explained that additional therapies might be needed depending on her individual case.  I said we would discuss those fees and treatments as the need arose.

 She had started sputtering whilst I was speaking, and she burst out “$85?  For that you only get acupuncture?”  I said, yes, acupuncture treatments cost $85, and she countered with “and that’s all, for $85?””  Her voice was rising, and in the background I heard someone asking if she was okay. She got herself under control and managed not to hang up on me, but it was a near thing and I MAY have been imagining the good-bye.

 I hung up, shaking my head, and went about my day.  But the whole thing has been bothering me.  I live in a large city, where people regularly go to Whole Foods for their lunch and Starbucks for their lattes.  They drive their large SUVs or their import cars through miles of miserable traffic, getting the worst possible mileage and pay some of the highest petrol prices in the country.  They have housekeepers.  They think nothing of going to Burke Williams for a massage and spending upwards of $150.  They regularly buy new clothes, eat out, buy music, and go to movies or the theatre.  The spend money like it’s Monopoly money, until it comes to their health.  Then, they want the most health care for the lowest price.

 Now, I’m not talking about the folks on a strict budget.  From those folks, I tend to get “Money’s really tight right now . . .” to which I say “As you probably saw on my website, I offer a hardship discount.” And they make an appointment, come in, and get their health back together.

 So what do really get for the price of a treatment in my clinic?  You get a health care practitioner who has spent more than 3000 hours in her initial training, as well as extensive, and on-going, post-graduate studies.  A practitioner who applies her knowledge of herbs, human physiology, diet, the five elements, Daoist study, theology and human nature to every treatment.  A practitioner who takes the time to talk, and more than that, to listen, with every patient.  To really hear what the underlying issue is.  A practitioner who won’t dismiss your health concerns, and who is part of a larger referral community so you are referred to other practitioners if that’s the most appropriate for your case.

 Not to sound like a greeting card, but your health really is the most important thing you “own”.  You really don’t have anything if you don’t have your health.  It’s important to find the right practitioner to become a partner in maintaining your health, not the cheapest.

 Think about it at least, and then go find the right health care practitioners to be on YOUR health care team.

What does that mean?

Does health mean physical vitality, mental acuity or emotional stability?  Or does health mean reducing the number of prescriptions in the medicine cabinet or the number of missed days at work?  For each person, health means something different, and is something we must each define for ourselves.

What would health look like to you and your family?

Would there be more time with your significant other or children?  Or would there be more money for vacations or special purchases?  Would it mean better sleep, and so, better days?  Would it mean gaining or losing weight and then being more active, physically or socially?  How would your family benefit if you were healthy?

What would it feel like to have health?

What would it feel like to wake up each morning without the lingering effects of disease (dis-ease) in your system?  What would it feel like to be able to function during the whole month?  Or plan for something three, six or nine months away?

For many people, this is a concept that is so far removed from their reality they refuse to entertain the notion.

For some, they’ve been told absolutely they CANNOT have health.  Perhaps this is true, but what if it isn’t?  What if the diabetic or hypertensive in your family could get treatments and actually “get health”?  What would that be worth to your family?  If you no longer had debilitating headaches or menstrual cramps?  If your back/neck/arms/legs/joints no longer ached/burned/throbbed?

And what holds people back from exploring their options?  Is it fear of failure or fear of success?

There are any number of terrible “invisible diseases” (Chronic Fatigue Syndrome / Myalgic Encephalomyelitis, Fibromyalgia, Lyme, Primary Immunodeficiency Disease and Dysautonomias to name a few) which it would be inappropriate to baldly state could be “cured” but what if the debilitating symptoms could be reduced.  And what is that worth?

A leap of faith?

Three or four visits to a health care provider who treats the whole body to see if you get any relief?

What if it worked?  What if it didn’t?

When counselling adult students returning to school after years in the workforce, I often had to field versions of this question. “What if, after going to school full-time for four years, I don’t go into practice as an acupuncturist?”  And I would answer them “What if you don’t.  At the end of those four years, you’ll have gained a Master’s degree, a whole new way of approaching health – yours and your family’s at least.  And you’ll be four years older.  If you don’t go to school, at the end of four years, you’ll have four years more experience in the world, that’s true, and you’ll be four years older, but you won’t have been exposed to the richness of experience you’ll get returning to school.  If you’re not sure this curriculum is the right one, go talk to other schools.  Maybe you’d rather study mental health, or education, or get a Masters in your current field.  Go take some time, listen to the voice inside you that’s telling you to return to school.  And remember, it’s only four years after all.”

They didn’t always come to our school, some went away and stayed in their jobs and some went to schools in other fields.  But each one of them let me know that they appreciated the reminder.  It’s easy to forget, but time is only time.

So what if you did go to, say, an acupuncturist, for a few visits?  What would you lose?  What might you gain?

What is your health really worth?

Upon receiving her (first – she’s a new patient) billing statement, one patient looked at the adjustments column and said “What’s this?” 

I told her that they are the contractual adjustments I make because I am an in-network provider with her insurance.  She was incensed – not at me, at the tiny tiny amount the insurance companies feel acupuncture is worth.  She asked some other questions, like why I didn’t change my rates.  I pointed out that even if I did change my fees, all that would happen is that I would have to write off larger amounts. 

It really did my heart good to have a patient get so upset on my behalf.

 I love what I do & I have the BEST patients!  Thanks to all of you.

Happy Rosh Hashanah!

For those of us who only know Rosh Hashanah as a holiday in our Outlook calendars, here’s a brief intro:

Rosh Hashanah, literally “Head of the year,” is a Jewish holiday and the first of the High Holidays which are days specifically set aside to focus on repentance that conclude with the holiday of Yom Kippur.  It is observed as a day of rest.  During the afternoon of the first day of Rosh Hashanah, or the second if the first falls on Shabbat, it is customary to observe the practice of tashlikh in which prayers are recited near natural flowing water, and one’s sins are symbolically cast into the water. Many also have the custom to throw bread or pebbles into the water, to symbolize the “casting off” of sins.

The traditional Hebrew greeting on Rosh Hashanah is shana tova for “[a] good year”, or shana tova umetukah for “[a] good and sweet year.” Because Jews and the world are being judged by God for the coming year, a longer greeting translates as “may you be written and sealed for a good year” (ketiva ve-chatima tovah).

Shana Tova  to all my Jewish patients and their families, friends and wider communities.  Let us all join together in the prayer that this new year will be a good and sweet one.

For more and more patients, insurance coverage for acupuncture is the make or break deciding factor.  I am pleased to announce that, through OptumHealth Physical Health of California, I will be a participating acupuncture provider for the following companies beginning 16th January 2010.

Great-West Healthcare
Health Allies
Medical Resource LLC
Secure Horizons
PacifiCare Health Systems
United Healthcare
Premera Blue Cross
Spring Hill School
Easy Choice Health Plan

I remain an in-network provider for Blue Shield of California.

If your health care coverage is with any of these plans, or any other, I encourage you to make 2010 the year you take control of your health.  Call to make an appointment and let acupuncture/traditional oriental medicine assist you toward radiant good health.

The Centers for Disease Control and Prevention issued the following update.  It has more to do with Public Health than Acupuncture, but I post it here as a public service since there may be a water frog or two being gifted this holiday season. 

Investigation Update: Outbreak of Human Salmonella Typhimurium Infections Associated with Contact with Water Frogs

CDC is collaborating with public health officials in many states to investigate a multistate outbreak of human Salmonella serotype Typhimurium infections due to contact with water frogs including African Dwarf Frogs. Water frogs commonly live in aquariums or fish tanks. Amphibians such as frogs and reptiles such as turtles, are recognized as a source of human Salmonella infections.  In the course of routine assessment, a number of cases with the same strain have been identified over many months. As of 11:59pm EST on December 9, 2009, 50 individuals infected with the outbreak strain of Salmonella Typhimurium have been reported from 25 states.

ADVICE TO CONSUMERS

• Always wash hands thoroughly with soap and water after touching any amphibian (e.g., frog) or reptile (e.g, turtle), their housing, or anything (for example, food) that comes in contact with them or their housing.   Adults should assist young children with hand washing.  
• Watch for symptoms of Salmonella infection, such as diarrhea, fever, and abdominal cramps.  Call your health care provider if you or a family member have any of these symptoms.

Persons who should avoid contact with amphibians and reptiles and their habitats (e.g., aquarium, fish tank, or terrarium)

• Persons at increased risk for serious infection from salmonellosis are children < 5 years old, elderly persons, and persons with weakened immune systems.
• These persons should avoid contact with amphibians (e.g., frogs) and reptiles (e.g., turtles) and anything that comes in contact with them (e.g., aquarium, habitat, and water).
• Keep amphibians and reptiles out of homes with children < 5 years old or people with weakened immune systems.

Placement and maintenance of habitats

• Amphibians (e.g., frogs) and reptiles (e.g., turtles) should not be kept in child-care centers.
• Habitats containing amphibians or reptiles should not be kept in a child’s bedroom, especially children aged < 5 years.
• Do not allow amphibians or reptiles to roam freely through the house, especially in food preparation areas.
• Keep amphibians and reptiles out of kitchens and other areas where food and drink is prepared or served to prevent contamination.
• Habitats and their contents should be carefully cleaned outside of the home. Use disposable gloves when cleaning and do not dispose of water in sinks used for food preparation or for obtaining drinking water.
• Do not bathe animals or their habitats in your kitchen sink. If bathtubs are used for these purposes, they should be thoroughly cleaned afterward. Use bleach to disinfect a tub or other place where reptile or amphibian habitats are cleaned.
• Children aged <5 years should not clean habitats.

• Always wash hands thoroughly with soap and water after cleaning habitats.

LEARN MORE

To learn more about the outbreak, read the complete update on the CDC Salmonella website. To learn about other recent outbreaks and incidents, visit the CDC Recent Outbreaks and Incidents page.

 Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)

Today’s blog is written by guest author Barry A. Wilson, a RAND research programmer and co-authour of such works as A Question of Balance: Political Context and Military Aspects of the China-Taiwan Dispute (2009); Measuring Interdiction Capabilities in the Presence of Anti-Access Strategies: Exploratory Analysis to Inform Adaptive Strategy for the Persian Gulf (2002); Dire Strait? : Military Aspects of the China-Taiwan Confrontation and Options for U.S. Policy(2000); Ground Combat in the JICM(1995); Analytic War Plans: Adaptive Force-Employment Logic in the RAND Strategy Assessment System (RSAS) (1990) and The Secondary Land Theater Model (1987).  These and other RAND publications are available in the RAND online bookstore http://www.rand.org/pubs/.

Like many Westerners, I suppose, I have never had much contact with acupuncture and Oriental Medicine (OM) and only thought of it vaguely as a folk art that worked more or less by accident.  I’ve since come into a much closer relationship with Oriental Medicine and have found that it makes sense to me in terms of my own profession, computer modeling. 

A truism about any model of the real world, computer or otherwise, is that it is wrong.  All models are abstractions of the world, and therefore inaccurate.  The question is, can you do useful work with a bad model, and the answer is of course, yes, as long as you remember that the model is not reality.  You can get insight into the real system by working with the simpler model.

Western science has created a model of the human body through the powerful technique of scientific analysis, taking the system apart and understanding each piece in detail.  To paraphrase an excellent author on understanding OM, The Web That Has No Weaver by Ted J. Kaptchuk,

Western medicine is concerned mainly with identifying and controlling disease.  The Western physician starts with a symptom, and then looks for a cause.

Pre-scientific people created models, too.  It’s what we humans do.  The ancient Chinese observed people for thousands of years and created a model along the lines of their Daoist philosophy of the balance of opposites in nature, Yin and Yang.  Again paraphrasing Kaptchuk,

The Chinese physician looks at everything about a person, all psychological and physiological characteristics, in order to see what is not in balance.  The question is not “Is X causing Y?” but “What is the relationship between X and Y?”  They do not look for a specific disease or cause to treat, but rather to discern the configuration of the signs and symptoms and then to bring that configuration into balance, to restore harmony.

The limitation of the analytic approach is that by focusing on the details it can miss the complex balances and flows that arise between the parts.  The ancient Chinese built their model through synthesis of the entire person and their relationship with the world.  Western medical science is just beginning to understand how important the mind is to health, and how personality does not stop at the skin.  The limitation of synthesis is that it remains largely an art, the human system seen as a whole is so complex that the experienced practitioner may not be aware of the thousands of tiny signs they are synthesizing into their sense of the balance and energy in the patient.

OM’s human model is in no way a simpler model.  Although it describes using simple opposites – hot/cold, dry/damp, Yin/Yang – each balance has its opposite within it, Yin within Yang, to potentially infinite regress.  And although it uses words that have been translated into the English words  such as heart or liver, these describe abstract functions in the model that are not related to any actual body part.

Where a Western physician might see 6 patients with similar symptoms and diagnose the same condition in each, an OM physician will see 6 very different individuals each in a different state of balance and would likely treat each very differently.  But because it sees each person as unique, it cannot be codified into cut-and-dried rules and taught as Western medicine is taught.  Western medicine has developed powerful techniques to treat severe illnesses.   My friends in OM would say, if you have pneumonia go see a Western doctor, but if you have a problem of systemic balance, such as chronic pain, fertility, recurring headaches, go see a person trained in observing your whole self.

As an abstract model, OM represents the human being better in some ways than others.  No doubt some parts are very poor representations.  But as a holistic model, you can’t carve off some parts and leave the whole intact.  OM is an incredibly sophisticated and complex model of the human system built through close observation of people over thousands of years.  In the hands of an experienced practitioner it can achieve results that are simply not possible using the analytic techniques of Western medicine.  The strengths and weaknesses of each approach should be understood and valued for what they are.

Buffy the Vampire Slayer said it (Okay, according to an anonymous reader Buffy actually said ‘Fire bad, Tree pretty’.  Thanks for keeping me honest mystery reader) and in a week like we’ve just experienced, that lizard-brain level is where we’re all operating.  With no wind, smoke from the “Station Fire” just sat over the Angeles National Forest.  And then, following the physics of “what goes up must come down” it rained ash.  Day after day after day.  In my office in Tarzana, ash was covering the parking lot and the smoke was overpowering the A/C’s ability to keep the smell out.  It was hot and dry and dusty and all-in-all a miserable week.

 So – why post THAT on this blog.  It’s not news to anyone in the area and the weather has changed, the fire is moving east and the ash is retreating.

I’m addressing this because of the huge affect this fire had, and is continuing to have, on my patients.  Several patients have come in for musculoskeletal appointments and have ended up getting treatments for respiratory complaints (and the musculoskeletal treatments too – that’s one of the powers of Traditional Oriental Medicine, I can do both at once!).  They’ve been physically and mentally tired, almost feeling they were coming down with something but with no specific symptoms.  This is due to their Qi not circulating well throughout their bodies.

In Traditional Oriental Medicine (T.O.M.) the Lungs govern Qi and respiration.  They’re responsible for inhaling Qi from the atmosphere, combining it with the Qi received from food and spreading the resultant useable Qi throughout the entire body.  The Lungs are called the tender organ because they are the most external organs and they connect the body to the outside world.  The Lungs are easily attacked by external pathogenic factors, in this case smoky, ashy, hot air.  When the air we’re taking in is poor quality, we tire easily.  Of course, when we’re breathing good air and eating garbage we get tired easily, but that’s another discussion.

Anyone with allergies/asthma or COPD should have a plan in place for fire season as should people with cardiac disease.  The easiest to follow recommendation is to stay inside with windows and doors closed, and run the A/C to filter out the gunk.  But even people with no cardio-pulmonary disease need to take care not to exhaust themselves.  The impact of the smoke is insidious and it would be easy to ignore the body’s signals to SLOW DOWN but it is very important to take it easy.

T.O.M. states that anytime the seasons change we need to take care to slow down and reflect on what our bodies are going through.  Add in a natural disaster and everyone can really benefit from some meditativetime.  I suggest doing something positive for yourself, especially something you’ve been putting off.  Go get a massage, visit a healthcare practitioner, read that book you’ve been putting off, go out to a special meal with friends or loved ones.  Whatever it is, take this time to slow down.  It will allow your body to adjust to the season change as well as recovering from the fire.

T.O.M. also has a long list of foods that are beneficial for the Lung system.  Some simple foods you may want to consider adding into your diet right now include apples, especially the sour ones like pippins; yogurt; tofu, tempeh and soybeans; rose hip tea; black tea; honey and barley malt.  For a more complete recommendation, make an appointment to see me or your local practitioner of Traditional Oriental Medicine.

For specific smoke related information, visit this page on the US Department of Agriculture Forest Service’s website:  Wildland Fire Smoke.  And for those of you in fire-prone areas, here’s a goldmine of information:  InciWeb Incident Information System

Having some seriously frustrating things happening with my blog right now.  Thank you to the reader who let me know things had gone haywire, a HUGE thank you to my hosting company inMotion for all their help.  And thanks for hanging in there while I try to get this all back and working.  Right now, there are obviously pieces missing somewhere in the code – and I just have to figure out how to resurrect those pieces.  I’m sure it will all work out in the end, just a little hiccup in the machine right now.  If you know ANYTHING about WordPress and want to offer me some suggestions, I’d welcome them with gratitude.

Up until the June 2009 issue, I’ve had very few complaints with the UC Berkeley Wellness Letter.   They’re a pretty conservative publication but they’ve had interesting articles and have seemed to be pretty balanced, until this issue.

In the Wellness made easy section on the last page, they published this:

Avoid “herbal” or “natural” weight-loss supplements.  The FDA recently warned that dozens of products contain hidden and potentially hazardous drugs such as diuretics or laxatives, or else risky prescription anti-obesity medication, often combined with a witch’s brew of other ingredients.  The supplements are usually sold on the Internet, but some, such as StarCaps (now recalled) are also sold in health-food stores and drugstores.  Most are made in China.  There are no safe and effective dietary supplements for long-term weight loss.

Wow.  So many things pop off the page in this blurb, the most upsetting being the combination of “witch’s brew” and “made in China”.  I checked this out by having some folks I know read the article to see what their reaction was.  They all looked at me and asked a version of the same question “Are the herbal formulae you prescribe safe?”.

The answer is an emphatic “Yes!” followed by a longer explanation of how, as a licensed acupuncturist in California I have been trained in prescribing these substances and how I buy my teapills (pre-packaged herbal formulae) from manufacturers who meet and exceed GMP standards.

As a practitioner of Traditional Oriental Medicine, I have an uphill battle in America.  My patients know the medicine works; herbs, acupuncture, dietary advice, lifestyle advice, exercise; they all work together to help my patients become healthier.   But when publications like the UC Berkeley Wellness Letter start throwing these scary phrases around, it has a strong impact on people who could benefit from T.O.M. but are hesitant.

This is what I sent to the Editors of the Wellness Letter:

Dear Editors,

I am a California licensed acupuncturist and I wanted to register my disappointment with the “Avoid ‘herbal’ or ‘natural’ weight loss supplements” article in the Wellness made easy section of the June 2009 issue.

I don’t object to the information, but I am offended by the phrasing “. . . combined with a witch’s brew.  .  . “.

Part of my training is to concoct prescriptions by combining substances in the Materia Medica of my profession, something I was extensively trained in and have earned the rights and privilege to do by passing the most comprehensive and difficult licensing examination in the country.

Just because your authours don’t understand the theories behind the substances in the offending products, doesn’t mean they’re ineffectual or dangerous.