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.

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.

This year has been so tough that it even intruded on writing this blog.  As I was assembling my thoughts and getting everything in order, a good friend called to tell me she has breast cancer – one breast for sure and probably both.  She’s on a fast track to surgery, which is good, she has a good prognosis, which is good but she’s still going through a lot.  And, because I care for her, the announcement has meant I am too.  I’m sharing this so you, whomever you are reading this, will know this blog isn’t some intellectual exercise, but is something I’m writing about because it’s affecting my life too.

This year has seen a lot of deaths as well as a lot of serious illnesses.  And grief can begin long before the actually death of a friend or loved one, human or animal.  Grief can also come from the death of someone famous, if the connection is strong enough.

But grief doesn’t only come from a death of a person or companion animal.  The loss of a job can cause a level of grieving similar to the loss of a person.  This year has seen a lot of folks losing jobs, or having family members lose a job.  The problem comes when a person is not aware that a life change like that can cause severe, real, palpable grief.  They wonder if there’s something wrong with them, feel like they’re losers – after all, they only lost a job and here they are feeling this great sadness.  Are they cracking up?  A total waste of a human life?  Totally weak?

The answer, of course, if none of the above.  They’re experiencing a very understandable shock/grief reaction and they need some support.  So if you know someone who has lost their job be kind to them and maybe even suggest they look for some support to help them through this time.

Ironically, other major life changes can cause grief.  Graduations, weddings, births, even a new house or apartment can be a situation where grief arises.  Our self-image is changing dramatically during these events.  Once we graduate we lose our identity as a student.  We come into a wedding as two individuals and leave with new identities, we are now married – a part of a team and the single individual we were no longer exists.  Women’s bodies dramatically change when they become pregnant, and over the course of their pregnancy, they begin to identify themselves with those changes.  Then suddenly, they give birth and they lose that pregnant woman to become a new mother.  And moving into a new house or apartment means that Mr. X of 1234 Green Apple Circle no longer exists and has become, instead, Mr. X of 5678 Calle Grande.  These are wonderful changes, but they can bring up grieving as well as celebration.

In acupuncture and Traditional Oriental Medicine (T.O.M.), the Metal element is strongly affected by grief.  The organ systems associated with Metal are the Lungs and the Large Intestine.  Practitioners will often treat Lung or Large Intestine points to help patients appropriately grieve by breathing in life and releasing the “crap” they’re holding on to.  Acupuncture and T.O.M. can help with grief, both new grief and long-standing deep-rooted grief.

Of course, just like everything else that acupuncture and T.O.M. can treat, various practitioners are more or less trained and able to treat grief, so if you or someone you love decides to try acupuncture and T.O.M. treatments, talk to a variety of practitioners before making your final decision.

As we move along the year, from the Autumn/Metal season to the Winter/Water season, grief can become solidified.  The basic nature of Winter is cold, hardening things and keeping things unchanged – frozen even.  By using appropriate warming techniques, herbal formulae and needle techniques; acupuncturists can help their patients avoid freezing into a pattern of long-term grief.

It’s not easy to talk about loss or the fear of loss but it is vitally important to reach out to someone.  If acupuncture and T.O.M. aren’t your thing, there are plenty of highly trained psychologists and psychiatrists who can help.  If you are of a more spiritual bent, there are clergy members of all faiths and denominations trained to help.  There are even special grief counselors.

So if you or someone you love is facing the terminal illness or death of a loved one, please remember there are a variety of avenues available to help you and that, unlike some of life’s experiences, it really IS best to share this experience with someone who has the knowledge, tools and compassion to help you through.

In Loving Memory –
J’hana
Michael
Robbie
Miriam
Baby Caleb

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.

Yes, even acupuncturists get to have fun once in a while.  So if things seem a little wacky, it’s not your screen – it’s a little cyber high-jinx.  Enjoy!

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

While acupuncture is readily accepted as a viable option for low back pain in mainstream modern medicine, there has been little research to prove that it works.  Now there are studies that support the clinical evidence.

In a German study published in the Archives of Internal Medicine, 1,162 adults with chronic, lower back pain were divided into groups treated with the standard pharmaceutical and exercise therapy commonly used in Western medicine and acupuncture. The researchers reported that acupuncture provided relief and lasting benefit to nearly twice as many lower back pain patients as drugs and exercise. Forty-eight percent of the acupuncture patients reported at least a one-third decrease in pain along with improvement in their ability to function, versus 27 percent of the patients treated with conventional methods reporting such benefits.

In the July 2009 issue of Acupuncture Today, they reported findings from a new study.  Published in the May 2009 issue of Archives of Internal Medicine this new study adds to the growing body of evidence showing the efficacy of acupuncture for back pain.

In this study, 638 patients suffering from back pain were divided into four groups:

Individualized acupuncture: This treatment was prescribed by the diagnostician at the beginning of each visit. There were no constraints on number of needles, depth of insertion or needle manipulation. Needles were retained for 18 minutes. Seventy-four distinct points were used.

Standardized acupuncture: This protocol used a standardized acupuncture prescription considered effective for chronic low back pain, including DU3, UB23 on either side, low back Ashi point, UB 40 on either side and KD 3 on either side. All points were needled for 20 minutes, with needle stimulation at 10 minutes and again just prior to removal.

Simulated acupuncture*: This technique used a toothpick in a needle guide tube. All acupuncture points were stimulated with toothpicks at 10 minutes and again at 20 minutes, just before they were “removed.” The acupuncturists simulated insertion and removal of needles at the eight acupuncture points used in the standardized treatment.

Usual care: Participants in this group only received the care, if any, they and their physicians chose. This was mainly medications, and primary care, and physical therapy visits. All participants received a self-care book with information on managing flare-ups, exercises and lifestyle modifications.

At 8 weeks all patients showed improvement, however, the “usual care” group improved only 2.1 points improvement, scored on a disability questionnaire, as opposed to the individualized, standardized and simulated acupuncture groups who improved by 4.4, 4.5 and 4.4 points respectively.

The greater improvement for the acupuncture groups continued to 52 weeks, the end of the study.

Researchers concluded that compared to usual care, acupuncture had beneficial and persisting effects on chronic back pain.  They stated the acupuncture treatments resulted in clinically meaningful improvements in function, and really, isn’t that the bottom line when you’re getting treatment for pain?

*Simulated acupuncture.  Ironically, this simulated acupuncture is known by practitioners by another name – acupressure.  Additionally, many of the earliest acupuncture practitioners used needles-like implements to stimulate a point but did not insert the implement into the body, or if they did it was a very shallow pricking insertion.  Full insertion into the body came later, so it’s no surprise to any acupuncturist that “simulated” acupuncture would work as well as acupuncture with needle insertion.

Low back pain is an extremely common concern, affecting anywhere from 75 to 90 percent of people at some point in their lives.  Low back pain is second only the common cold as a cause of lost days at work and is one of the most common reasons to seek medical care, including acupuncture. In fact, one of the top reasons that people get acupuncture treatments is for low back pain.

The Oriental Medicine Perspective of Low Back Pain

In spite of the large number of pathological conditions that can give rise to low back pain, up to 85% of the cases are classified by Western physicians as ‘non-specific’. When low back pain is looked at from an Oriental medicine perspective, it is seen as a disruption of the Qi within the area and associated with a specific disharmony and then treated accordingly.

The basis of acupuncture is expressed in this famous Chinese saying: “Bu tong ze tong, tong ze bu tong” which means “free flow: no pain, no free flow: pain.”

In other words, any kind of pain or illness represents an obstruction in the normal flow of Qi or life force. Simply put acupuncture moves Qi restoring free flow.

The disruption of Qi that results in low back pain is usually associated with the following three disharmonies.  When reading these descriptions, please bear in mind the differences between Western anatomical organs and Oriental Medicine’s organ systems.  As distinct from the Western medical concept of internal organs, this concept from Traditional Oriental Medicine is more a way of describing a set of interrelated parts than an anatomical organ. To differentiate between western or eastern concepts of organs the first letter is capitalized, therefore, in the description of weak Kidney Qi we are in no way associating this with disease of the kidney.  If you have questions on this, please drop me an email or send me a text and I will explain further.

Weak Kidney Qi – In Oriental medicine, the lower back is referred to as the “dwelling of the Kidneys. The majority of chronic low back pain conditions are associated with Kidney Qi Deficiency. This type of pain is dull and comes and goes. It is usually aggravated by over tiredness and improves with rest.

Stagnation of Qi and Blood – When the flow of Qi along the meridians that traverse the lumbar region becomes congested, it is referred to as the stagnation of Qi and blood. This presents with a severe stabbing pain that is worse with rest and better with movement, tender to touch and can be accompanied by stiffness and tightness.

Invasion of Cold and Dampness – Cold, damp type pain is worse in the morning and when the weather is cold and damp. This type of pain Improves with movement and the application of heat.  Stiffness and contraction of back muscles that is aggravated by rest indicates cold predominance while swelling, numbness and a heavy sensation are indicative of dampness.

Next time – Studies on Acupuncture and Low Back Pain