Archive for the ‘Process of healing’ Category

The good news about arthritis – it’s not as simple as you’ve been told…

Saturday, October 31st, 2015

“…they found that it is very common for people to be walking around without any pain who have terrible joints!”

 Knee pain pic

Western medicine is updating it’s understanding of why arthritis hurts – the answer is that they are not completely sure anymore.

For most of the 20th century, the arthritis story was very simple.  The patient was told “See these changes on the X-ray/ MRI? That’s what is causing the pain.”   Patients then feel educated while they wait for for the surgeon – back fusion, knee replacement etc. etc.  The expectation is, if no change to the bone and cartilage of the joint – no pain relief.

But in the 21st century, new information has made that picture become less clear.

Researchers began to ask questions:

For example, if the bone pathology causes the pain, why does it not hurt all the time?

Why do some people have flare ups of pain after overeating?

Why is it when people actually have corrective surgery, the pain does not always go away?

Finally they began to take X-rays and MRI’s of people who are totally without any pain or stiffness.  To their amazement, they found that it is very common for people to be walking around without any pain who have terrible joints!  Even when finding the dreaded “bone on bone” situation.

In fact, if radiologists have never met the patients and only look at the X-rays, they cannot predict which patient has no pain, which patient has pain and if so what kind of pain they have in terms of location, intensity and frequency.  Some predictability is possible for very severe cases, but even then, not always.

This is really good news – the patient can now explore all the other factors for why the joint may have pain and stiffness, with reasonable expectation of preventing or delaying surgery.

So what does cause the pain?

The research suggests that arthritic changes to joints happen against the background of many other changes to nerve physiology, tendons, ligaments, muscle and immune system physiology.  There can also be a significant stress/ psychological component.

Using the word”physiology” here very specifically refers to changes in gene expression, enzyme function, immune function lymph and blood flow changes, as well as biomechanical changes.  Many of which have been shown to be reduced or eliminated by electroacupuncture, bodywork, herbs, nutrition and lifestyle factors.  (I will have a more detailed post about the science of pain in a few weeks.  Try Googling “genetic control of central sensitization” if you are curious before then.)

This explains situations I see in the clinic.  I often have patients who have been told that they need surgery but wanted to try acupuncture first.  Well of course, those of you familiar to my practice know it’s not just acupuncture that they may need. These patients receive a thorough review of their current and past global metabolic situations before various procedures and options may be utilized.

What can be done about the pain and stiffness then?

old-couple-jogging-healthy-ageing

Consider the following situations for patients with osteoarthritic pathology seen on an X-ray or MRI. When I find trigger points in the thigh muscle, the arthritic knee pain can go away completely in 1 or 2 sessions.  When a patient regularly overeats on foods that cause inflammation, 3 or 4 weeks of digestive repair and lifestyle changes can also restore function.  Some folk are over exercising or doing the ‘wrong’ types of exercise, some are too sedentary and do not know how even just a little more activity will create a big change.  Some people do not even need office procedures at all but need to simply move the joint regularly throughout the day in the range without pain.  This will allow the lymphatic and blood circulation to improve.  Also common is pain in a joint on a limb that had previously experienced poorly healed strain and injury – e.g. clearing the effects of an old neck injury can help wrist or hand pain.

We you come to see me, I take the label from your surgeon’s diagnosis off the the table for a moment and look at the whole picture.  A good diagnosis means a good treatment, and understanding the whole person is the best route to the best diagnosis. Detailing what the body needs allows us to design treatments using many options to surround the problem and get stable progress.

Happy healing!

Still limber

 

 

Try all your pain relief options before reaching for ibuprofen

Friday, July 31st, 2015

FDA recall

I try to avoid fear mongering on my posts but I have been feeling a growing moral pressure to tell the new ibuprofen story for some time.  After reading how long term higher dose ibuprofen use can have the same heart attack or stroke risk as Vioxx, the time felt right to update you all on the issue.  Vioxx was banned by the FDA as unsafe. (The Lancet 2013 382:9894;746-8)

Ibuprofen (aka Advil©, Motrin© etc.) seems harmless enough.  Maybe you’ve worked out too hard, maybe you have arthritis, maybe bad period pains.  For many mild pain patients, this pill can be quite a satisfactory pain management tool. I have taken it myself occasionally.  It certainly is more forgiving than acetaminophen (Tylenol© and other brand names), where even one or 2 pills past the regular dose can land you in hospital with liver damage.

However what I see in my clinic is that people keep taking it.  They come to rely on it.  Some athletes and military personnel even call their daily dose of ibuprofen “Vitamin I”.  And like many chronic self-medicating patients, over time the dosage and the risks go up as the benefits diminish.  I see multi-year users describing how the pain goes down just a couple points, say from a 6/10 to a 4/10 yet when they started the drug totally eliminated the pain. So now they have all this risk just for a minor nudge of pain levels.  Not worth it.

They masked the pain and prevented themselves from learning about the cause and effect their choices had on their body.  If you can learn where cause and effect impact your life, your quality of life will blossom in many profound ways.

Basic common sense suggests that it is better to understand and change the root cause of the pain rather than trying to suppress it once injury occurs.  Working with a professional such as myself will allow you to identify why you have that inflammation so often – and no its probably not aging!  I discuss everything with patients from shoe choices to making sure you vary your workout routine based on your body type.  The treatments I offer can eliminate the need for the drugs completely and can even help with issues like weight loss.

Take the example of arthritis.  I will post more about arthritis later, but a sneak preview here is the fact that the bone changes themselves do not cause the pain directly.  Arthritis pain is now understood to be very complex, and involves changes to the immune and nervous systems.  Note that many people with the bone changes do not have any pain at all!  You cannot predict pain levels just from looking at an x-ray.  Obesity is ofetn the difference between pain or no pain.  Seeing me to kick the ibuprofen habit for osteo-arthritis allows you attack the reasons for the pain in a safe, controlled manner.

So what are the risks with ibuprofen?

Well for example, a dose of hard exercise normally causes minor intestinal tears in healthy people.  These tears usually heal up just fine.  But the ibuprofen makes them worse and can can even slow the repair, so over weeks and months you are causing quite a bit of damage.  Beyond the digestive damage directly, weakening the lining of the gut causes all kinds of other inflammation such as in joints or the heart, or blood vessels – especially those in the brain. (from “Medicine & Science in Sports and Exercise” December 2012 44:12; 2257-62).

The Physician’s Desk Reference 2015 lists several other issues.  Cardiovascular risk including stroke and heart attack.  Renal papillary necrosis (the tissue has died) and other renal injury leading to possible kidney failure, liver failure, blood pathologies.  All noted that risk increases with duration of use.

All of this risk is really quite unnecessary.  Call me, call your PT DC DO LMT etc. etc. and start living pain free without damaging your health.

I found this chart on Pinterest.  It is not complete, e.g. does not have the cautions about using if you are diabetic or asthmatic,  but I hope you find it informative.  (You have to click on it to see the detail…)

NSAID risk

 

 

 

 

Real acupuncture is often ignored in clinical research

Saturday, January 31st, 2015

 

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When providers dive into the clinical research about acupuncture and pain, they find many papers that conclude acupuncture is simply a placebo. Yet what the papers are calling”real”, “true” or “verum” acupuncture is often not.  This post is a brief discussion about this issue, written for the lay person.

Research often A./ oversimplifies the diagnosis and care that patients receive in real clinical situations and B./ misses many important phenomena that require investigation.

A./ Oversimplified diagnoses and treatments

The actual care L.Ac.’s provide to their patients could be compared to an equation,

Treatment = [the exact nature of the problem] + [many individual details of the patient]

Due to time and money constraints, the second term is usually ignored and the first term is over simplified.   So for a study looking at back pain, the patients are all grouped together without clarification of their stress levels, psychological history, exactly what tissue/ muscle group is causing the pain, how genes involved in central sensitization are being expressed or not expressed, levels of blood markers for inflammation, other metabolic differences, etc. etc. The study looks at this group of patients with this wide variety of physiological states and gives them all one label, eg. mechanical back pain.  The study then puts severe restrictions on what points the practitioner can use and how to use them, due to the limitation of the statistics they want to use at the end.  The practitioners then cannot change anything to match the individual needs of the patient when it appears early in the care that that point prescription will not work for them.   In other words, the forced clinical behavior in the study would not survive the first week internship in any acupuncture school.

Imagine 2 patients aged 60 with a slipped disc at L5 causing back pain.  One is a robust ex pro football payer with years of fibrosis and fat marbling in the muscles around the injured nerve. The other is anemic, hypothyroid and who lived a very sedentary life and is also being treated for anxiety due to an abusive marriage.  The ball player may receive thick needles with strong stimulation with 100 Hz electro-acupuncture and deep tissue massage. Most L.Ac.’s could predict that were I to provide the same treatment in the anxious patient, I would likely make them worse.  The patient with an anxious, weaker metabolism needs a much lighter touch so as to not trigger the flight or fight reflex nor increase fatigue or cause other damage.

This is common sense, but is in fact quite difficult to add this common sense into a clinical study using current research techniques.  Unfortunately, the poorer quality studies are not removed from the statistics of the meta-reviews so we have quite a bit of “garbage in, garbage out” when maths is applied to the body of the research.

B./ Phenomena missing in the research that could disprove placebo predominance

I find the really interesting thing about acupuncture is that when I change something in the treatment that the patient is not aware of, their symptoms can change suddenly.   As I fine tune the treatment, I can see symptoms get strongly better or even strongly worse.   Thus I can navigate the patient to improvement in a very clear manner.  A placebo would not be able to have this power.

Even testing points before needling shows wide variety of results, allowing me to choose the best points.  Migraines are a great example.  I ask the patient “When I press on a point, please tell me if this makes the pain worse, better or has no effect on the pain.”

If acupuncture was only placebo, why do some points make the patient feel worse and some make the patient feel better?  With light pressure on one point, immediate exacerbation. With light pressure on another point, an 8/10 headache can completely clear.

Again, due to limited funding and the limits of current technology, many of these sorts of daily phenomena are not brought into the peer reviewed clinical research but do show up in the basic investigational research. They are crucial to elucidating the physiological mechanism of “real” acupuncture.

The moral of the story is that when you receive treatment by an L.Ac., they will pay attention to you and your symptoms in order to always try to optimize the best outcome during care.

 

 

 

Working with babies, children and young teens

Friday, August 1st, 2014

Treating children with the respect that an adult expects –

Boundaries, guarding behaviors and earning a child’s permission to treat

I treat young people experiencing a wide range in the intensity of their discomfort.  Sometimes its a straightforward orthopedic case – say repeated ankle fractures from skateboarding or muscle strain from athletic training.  They can present as forward looking kids, motivated to get back to the fun and relieved to find someone who says they can help.  Or a bad flu – they are so symptomatic the child is ready to just have all the aches and pains all go away.

Other cases present with more significant issues about how they feel about their bodies and their stress. Sometimes, in a young body having trouble, there is a lot of guarding.  I see guarding presenting in many ways – the child may not want to show me where its hurts, they may switch to ‘wiggle worm’ mode and bounce around the office, they may not want to talk about anything at all.

At this point my first comments are commonly directed towards the embarrassed parent.  I say ‘Look, this behavior is ok.  Its just where they are at, and we’ll start from here.  My first job is to earn their trust.’   I engage with the child to see why they are behaving as they are, before I try to do anything about it.

‘Why is my child not ready to just lie down and receive treatment?’

In many cases of headache or belly pain, I commonly see that I am meeting the child after they have been through a very intense round of biomedical diagnostic procedures.  Scans in loud machines, invasive and painful scopes – it may have all been appropriate at one level (dangerous pathology does of course show up in children and we may need to screen for that), but it was not ok with the child.  With the best intentions, the earlier therapeutic relationships have been a source of wounding.  This is a point where it is often easy to earn trust – I simply promise not to do anything they don’t want me to.  No sudden surprise attacks with acupuncture needles like, say, an earlier vaccine experience.  I will ask a young child where it is alright for me to examine or to do gentle acupressure, and start there.

My most difficult case have rarely needed more than one or 2 sessions before I am trusted to apply any actual therapeutic techniques.  We may start with herbs, we may start with CranioSacral therapy or other bodywork techniques.  But once they experience that I am on their side, the child looks forward to sessions.

‘But what if my child really needs acupuncture specifically?’

Once trust is established, my pediatric training and experience has prepared me to engage with acupuncture in several ways.  Depending on the situation, I may let the child tap a needle into me to show it doesn’t hurt.  I may talk about what to expect, that they may feel a gentle pinch so I let them pinch me and then I pinch them gently to see what its like.  Often, once I have the child’s trust, I can use a needle at a point while I’m talking to them and they usually don’t even feel it.  Needling very young children (I have given acupuncture to young babies, days old) is simply a matter of lots of hand pressure around the area, a quick pop of the needle and then withdraw.  Very different than the adult approach of retaining the needle for 30 minutes and trying to get big stimulation.  With all of my techniques, the child usually loses interest in what I’m doing and falls asleep.

‘Is acupuncture safe for children and babies?’

The mainstream peer-reviewed pediatric journals regard properly performed acupuncture with children to be very safe.  I will discuss the literature in a later post.

 

 

Severe hayfever treated with great success

Thursday, July 24th, 2014

Multiple techniques make patients more comfortable, sooner

Some of my patients go through a lot of side effects with their allergy medication, for which the drug(s) does not work or at best only takes the edge off of the symptoms.  Fatigue, nausea, diarrhea, it just didn’t seem worth it for such little benefit.  They also report having tried ‘allergy shots’, or other alternative therapies like herbs and even acupuncture but nonetheless, the symptoms are still there, they live in the Willamette Valley ‘allergy megastorm’ and their symptoms are grim.  In difficult cases, I find one cannot always rely on a single treatment approach, that creating multiple influences on the body all at once acts as a catalyst, creates a synergistic effect that takes care of each factor that contributes to the problem. When you cover all the bases, the body can more rapidly adjust into long term clearing of the symptoms.

One diagnosis, many contributing factors

These cases can present with strong sinus headache, totally blocked nose, sore throat from mouth breathing, eye irritation, cough, social problems.  In my practice I find that a patient in this situation has many issues in the body allowing such strong symptoms.  The blocked nose can be due to or worsened by trigger points in the face and strain in the fascia relating to the mucous membranes.  Diet may be promoting metabolic activity that continually creates inflammation.  Life stress and adrenalin may be pushing the immune system into overdrive.

In the first visit, I evaluate these various types of factors and, together with the patient, create a set of therapeutic goals.  Each modality has overlapping effects but the basic outline could be as follows:

Trigger points are cleared with manual body work.  Life stress is calmed with CranioSacral therapy and acupuncture.  Herbs are provided to counteract the diet and reduce inflammation. Electroacupuncture is applied to reduce inflammation and rapidly open the nose so the person can breathe normally.

I have been practicing so long that I understand my tools, and in a 45 minute session can apply different procedures in a harmonious, smooth manner.  Most people just fall asleep on the table while I work, and afterwards find that they can breathe, that the itching is gone and that they can speak without throat pain.

The goal is to move towards a long term, stable clearing of symptoms.

Repeated treatments are given to make the effect last longer and longer.  The different contributing factors resolve at different rates, so the treatments change over time.  The complicated, multi-modal session I describe above eventually reduces to just one of the techniques, applied with decreasing frequency until no longer needed.  So just before ending regular care a patient may need an acupuncture treatment once every 6 months, or just need a $5 bottle of herbs to take a few days a month.  It does vary.  Often the results last into the next allergy season or longer.  From a biomedical perspective the allergy may still be detectable in blood tests (or not), but the body’s reaction to problem antigens has been successfully and stably eliminated.

 

 

 

Do you think its age causing the trouble?

Monday, July 21st, 2014

In many cases I see, it’s not really age.
Our bodies need three things to be thrive –
…Good Sleep
……..Good Nutrition
…………..and Good Movement!

Many of my over 80 patients (and even younger) experience poor mood coming from how their body just isn’t what it used to be. I regularly hear “My mind is so much better than my body but I don’t know why.”

My response is that the answer is obvious – the mind has received all the attention! They do crosswords, listen to music, watch TV, read, socialize. But over the course of the day they are largely immobile. Use it or lose it, if you spend time with the “equipment” it lasts longer.
The amount of movement you need to feel a lot better is not a lot of movement. This is the surprising thing.

Of course if you do Tai chi and take a regular class you will feel improvement.  But in my clinical experience many people can increase mood and reduce pain by developing the habit of moving something every 15 minutes. Just like a dog or a cat – every few minutes, move something for a few seconds.  Reach up in the air, jab a few shadow boxing moves, lift one leg, then the other.  Even people with severe disease who are in bed can usually find some part of their body that can move freely. Even just straightening up and breathing deeply once or twice can help.

The classical chinese medical view is that the blood flows to where function is happening, the function happens in places where the mind engages that function.

For the average person, who is well enough to walk into my office when they come for a session,
Here’s the plan to start:

Every 15 minutes over the course of your day, stand up.
Every 15 minutes move your arms or your legs for 7 to 10 seconds, try a variety of directions including up and behind the back.
Move within a range of motion that causes no pain what so ever, no matter how small a movement this may be.
Give it a week and see how you feel!

What does getting better look like when using Chinese medicine and acupuncture?

Thursday, November 21st, 2013

Progress and clinical success at my clinic can be experienced quite differently compared to using drugs or surgery.

• For people who had complete relief or otherwise fully achieved their clinical goals, we can look back in their chart and see that some treatment days or weeks were better than others.

• Sometimes people notice improvement right away, sometimes over the next day or two. We know the results of an office procedure within 1-2 days of the session.

• Sometimes the treatment can occasionally irritate the problem initially and then feel better later. When symptoms return, they are less intense than pre-treatment.

• It is normal for symptoms to fluctuate anyways, especially those influenced by activity and stress levels. We keep track of it all, looking for the trend and adapting care as events warrant.

• Before treatment starts, it is not common for people to follow their symptoms with a high level of detail especially objective detail. After we start working on the issue, we tend to pay more attention which of itself can change the experience of the problem.

• In general there are 2 phases of healing. First we deal with the legacy of the situation, i.e. the accumulation of stress on the system from the past. There is then a phase where healing the past is over and we then aim to increase performance out of the affected system, so that damage from ongoing circumstance (perhaps beyond our control like a job situation) do not cause trouble.

It can be difficult remembering how bad a situation was before care started. If you are not certain how you are doing, lets talk about it and look through your chart. I once had a patient with knee pain who was sad that she could not hike 5 miles like she used to, even after 3 weeks of care. 3 days before her next session she had tried the long hike and failed due to pain. I was able to reassure her with her chart notes.

At her first appointment, she could not walk from the car park to the office and had to have her husband drop her off due to the pain. She had been this bad for 6 months before acupuncture, while in hesitation about whether to do surgery or not. On the day we addressed her progress concerns, she had come in unaided from the car park and in fact had several 1-2 mile hikes in her chart (from second week of care), where she only had 1/3 to 1/2 the pre-treatment pain level.

This was an otherwise normal, emotionally healthy person who simply lost track of this fine level of detail due to being very busy in her life, and also feeling the sting of recent failure.

Looking at the trend was all the reminder she needed to to continue care through to successfully getting back to her long hikes pain free. She did not need surgery within one year follow up, the medical cause of the pain was really one of trigger points and neuropathic pain more than being due to the findings on the MRI.

Returning to exercise safely & injury free (or “You’ll get there in the end”)

Monday, October 21st, 2013

Returning to physical activity is like making a camp fire. Making a camp fire means understanding fire’s nature, and acting appropriately.

How to make a nice roaring camp fire:

Start with a tiny spark from a flint or a wood drill.
If you add the spark to a log, it’s extinguished right away. If you blow too hard on the spark, that will overwhelm the spark as well.

The spark must be carefully cultivated with an understanding of its nature.

The successful spark goes on dry moss, maybe sawdust. Then more sparks form, then you can add more moss. Now, maybe a small wood shaving, then another. More moss, then a small twig. Never large pieces at this stage. Some gentle air from the breath is good now.

Then add several twigs, maybe some more moss. Then a bigger piece of wood, then large sticks. Now blow hard as possible, stoking the heart of the fire.

Now its ready for logs that will achieve the desired function of keeping warm.

This whole process totally fails if you push the envelope too soon. Yes, fire needs wood and yes it needs air, but these can smother the sparks if used at the wrong moment.

If you judge the small spark as being useless, you will never get the benefit from it. A large, warm fire has very humble beginnings but the beginnings exist and have power to develop.

Translate this analogy to exercise –

The goal of the first week or more is to simply get used to moving without triggering pain. Let the body be gently reintroduced to gravity and perhaps the kind of activity you intend to carry on with.

The goal is not to go for endorphins, stress relief, weight loss or other athletic performance. Get this goal correct and you are on the quickest path to victory. Anything else is risky.

Many people are hurting themselves by judging their own small spark of capacity to be useless and either overdoing it or deciding to do nothing.

I once had a patient only able to do 5 seconds of a shoulder qigong exercise I prescribed. This was case where workers comp covered work on the ankle but not the preexisting shoulder issue so she asked for a self-care protocol. But at 6 seconds, severe pain kicked in. This small functionality made her upset. She felt useless, thinking that 5 seconds was a fail. I recommended that she just do the 5 seconds. She was convinced that 5 seconds was completely pointless and we spent some time talking about this. She agreed to try the 5 seconds every day. After all, at 5 seconds at least there was no pain. In a few days she could do 10 seconds. In 2 weeks she was doing 10 minutes twice a day, and this finally took her into the range where the exercise made the shoulder feel pain free.

A more commonly used example I use for very overweight people over 75, who are in recovery from surgery or prolonged illness. I start these patients with 5 minutes per day on a playground swing. Sounds almost silly, but it moves a lot of lymph around and gets the body warmed up. From this innocuous beginning, within 6 months many can walk several miles a week or return to a keep fit class.

The moral is this –

It is totally irrelevant how small your abilities are when you start. Start where you are at, learn to enjoy the fact you have that much function at all. Development of your performance will then come without injury and with a deeper understanding of your own body’s needs.

Improving Your Diet: why its hard, why patience and neuro-plasticity will help

Tuesday, October 15th, 2013

‘Why do we eat food that creates trouble for us?’

We frequently create a nutritional culture based on how recipes make us feel in the short term. The meal size, the textures, and certainly the flavors, feel nourishing and efficiently banish hunger for at least a few hours. But unhealthy meals often make us denser, providing a strong feeling of fullness that can push away awareness of more subtle physical or emotional sensations.
This meal is like an antidepressant, and in fact, junk food alters brain chemistry along the same pathways that cocaine does. Our feelings of boredom or stress; feelings that we have given too much to others or that we deserve a treat for hard work or for dealing with difficult circumstances – these frequently make us reach for the sugar, fat and salt that successfully trigger our brains’ pleasure centers. Our brain is trained to place value on this experience. The numb feeling provides a nice distraction from the troubles. Real stress can be created when lose this distraction.

‘How does a person even know which meal is fulfilling the priorities of our health needs?’

Without any immediate food sensitivities in the body, the effects of diet on our health appear very slowly. In fact, the conventional wisdom that says steamed vegetables and fish is “healthier” than a bacon cheeseburger came from over a hundred years of scientific research looking into the food behaviors of tens of thousands of people. The immediate benefit of ‘healthy food’ is very difficult to perceive in an individual in a short span of time. Give an average, healthy person a fish and another person a cheeseburger, measure their vital signs then re-check in a few hours. Both would be absolutely fine. No wonder making the change is difficult. On a meal by meal basis one needs blood analysis to see any difference.

‘How does change happen?’

As we begin to make a diet change, we rely on our intellect to understand that our diet is not nourishing our health needs. We read or hear lectures about what foods foods are currently thought to be disease promoting or disease preventing. We frequently hear conflicting information as well, just to add to the difficulty. In the beginning, we simply do not have the direct experience of cause and effect. And of course there can be frequent feelings of guilt or even shame as our intellect is found to be insufficient to fight all the emotional energy around leaving the old ways behind.

But after a time a new feeling happens. We have more energy, our digestion improves, our bodies feel lighter and we work more efficiently. Symptoms of inflammation improve. Weight can be lost. As we experience the reality of cause and effect, our emotions change. Instead of placing value on the numbing, short term effect of unhealthy food, our minds learn a new way of perceiving value. This happens by a process scientists call neuro-plasticity, the ability of our minds to be reshaped by experience.

Our emotions now relate to time in a new way. The experience of feeling great over the course of several weeks outweighs the immediate gratification of numbness. We have changed the part of ourselves that responds to food from one that enjoys the break from feeling bored or stressed to the part that feels forward looking and healthy.

So the moral of the story is be patient and observe, your brain will handle the rest.