21 Suggestions for Success

This primer by NYTimes best-selling author H. Jackson Brown Jr. has made the internet and social media rounds, but as we fast approach the half-way mark of 2012, it deserves a little refresh!

1. Marry the right person. This one decision will determine 90% of your happiness or misery.
2. Work at something you enjoy and that's worth your time and talent.
3. Give people more than they expect and do it cheerfully.
4. Become the most positive and enthusiastic person you know.
5. Be forgiving of yourself and others.
6. Be generous.
7. Have a grateful heart.
8. Persistence, persistence, persistence.
9. Discipline yourself to save money on even the most modest salary.
10. Treat everyone you meet like you want to be treated.
11. Commit yourself to constant improvement.
12. Commit yourself to quality.
13. Understand that happiness is not based on possessions, power or prestige, but on relationships with people you love and respect.
14. Be loyal.
15. Be honest.
16. Be a self-starter.
17. Be decisive even if it means you'll sometimes be wrong.
18. Stop blaming others. Take responsibility for every area of your life.
19. Be bold and courageous. When you look back on your life, you'll regret the things you didn't do more than the ones you did.
20. Take good care of those you love.
21. Don't do anything that wouldn't make your Mom proud.

 . . . and for my two-cents:
22. Laugh wild

Pushing the Point: Integrating Acupressure and Chinese Medicine in Psychiatric Nursing Practice

Integrative therapies are all the rage, particularly in psychiatric and mental health settings. It is an honor to be accepted for a pre-conference session at the American Psychiatric Nurses Association's 26th annual conference in Pittsburgh this November. Check out the abstract! 

ABSTRACT: With the rising costs of care, decreased reimbursement for services, and shortage of mental health clinicians, patients and providers are increasingly researching and incorporating integrative therapies as part of a holistic care plan. A review of the literature revealed a growing evidence base for the integration of Traditional Chinese Medicine (TCM) therapies with allopathic medicine. This has prompted nursing schools across the country to include education on TCM in their curriculums, encouraged hospitals and clinics to add TCM therapies to their list of psychiatric services, and resulted in development of new protocols for addiction, PTSD, and pain management. Acupressure, a component TCM, is a noninvasive, integrative modality that can help alleviate common symptoms such as stress, anxiety, depression, mental fatigue, and insomnia, while reducing barriers of cost, time, and deleterious medication side effects frequently found in PMH treatment. The session will review basic TCM theory and evidence base, describe the function and energetics of acupoints useful in a variety of Psychiatric/Mental Health settings, and provide a live demonstration of common techniques.

PRESENTATION SUMMARY: Part of the greater system of Traditional Chinese Medicine, acupressure is an effective yet underutilized modality for relieving common psycho-emotional symptoms. In both the inpatient and outpatient setting, TCM principles can be adopted to help alleviate stress, anxiety, depression, mental fatigue, and insomnia. This session introduces basic evidenced-based acupressure theory and techniques through discussion and live demonstration.

OBJECTIVE 1: Describe the theory and benefits of using Traditional Oriental Medicine techniques in the psychiatric and mental health setting

OBJECTIVE 2: Identify the functions of ten commonly used acupoints that can be integrated into treatment plans of patients with psychiatric and mental health disorders

OBJECTIVE 3: Discuss methods for integrating TCM modalities with conventional PMH nursing practice.

Spring Allergy Help

Spring winds are slowly clearing winter away, and with them can come an onslaught of ear, nose, and throat woes. In order to enjoy the beautiful blooming of the season without burying your head in a tissue, take a look at this self-care sheet for strategies to prevent and treat seasonal allergies.

Product Highlight: Omni-Gym

Anti-gravity and aerial exercise have been making waves for the past few years, though many gyms are hesitant to offer the trend. These suspension systems provide no-impact, body weight resistance training to promote flexibility strength and balance. They can help decompress the spine using a variety on inversion techniques appropriate for those with everything from bulging discs to fibromyaligia without the ankle strain many of the standard tables provide. Plus you can at least momentarily pretend you are in your own Cirque du Soleil show!

Not all systems are created equal and not everyone has the ability to install the apparatus safely in their ceiling or doorway. I recently came across the Omni-Gym offered by Yoga Swing and am impressed with the variety it offers at a price less than many home gyms. We plan to provide a personal review in the near future, but in the meantime, take a look for yourself. They are offering discounts through March on the total system if you are waiting to wait a few weeks for delivery.

The most versatile suspension fitness trainer you'll ever own!

From the creators of the original YogaSwing, Omni-Gym™ brings you the best health and fitness suspension swing technology out there.


The Omni-Gym will take your fitness and flexibility routine to a whole new level: As you are suspended in space, your workouts are entirely body-weight oriented and therefore highly effective. You will find yourself stretching and strengthening muscles you didn't even know you had! Used by athletes, gymnasts, martial artists, dancers, yogis and fitness buffs worldwide, the Omni-Gym is truly one of those versatile workout tools that can be adapted to whatever kind of workout or stretching session your body (or profession) most requires.


Not only is the Omni-Gym an incredibly effective suspension fitness, martial arts and sports trainer, but just like its predecessors it is an amazing anti-gravity yoga/stretching and aerial dance tool. And don't forget it does wonders for back and neck care.


Oh, and did we mention that it is easily portable, quick set-up, multifunctional and FUN? what more could you ask more!


Check out www.OMNI-GYM.com to learn more

Join the Movement!

Recent Favorites in Self-Care

We are six weeks into the new year and the enthusiasm for goals or resolutions may be waning or have been abandoned. Since health and wellness are almost always on everyone's let for improvement,  wanted to share some of my favorite tools and products I have been recommending and personally using for health promotion and disease prevention.

You Are Your Own Gym by Mark Lauren
Long, steady state cardiovascular exercise may have it's place when training for races, but in the real world, functional training that encourages strengthening of the muscles you use most for activities of daly living should be the focus of any exercise plan. This book has over 100 body-weight exercises, some of which incorporate common household items, with 10 different methods of combining them for an optimal 20 minute fitness routine 4 times per week.

Personal Training With Jackie: 30 Day Fast Start
This DVD offers two 20-minute workouts, one upper and one lower body, where you combine two exercises in sets of increasing reps. Short, powerful, effective with minimal equipment needs.  It is a great addition to her XTreme Timesaver DVDs and book This is Why You're Fat.

Pure Lean Protocol Weight Management
All the supplements you need in one box without a lot of unnecessary additives. This set includes choice of pure or blended whey protein powder in chocolate or vanilla, pure lean fiber, and a daily pure pack containing a multivitamin, Omega-3,  magnesium, alpha lipolic acid, and taurine. For about $2/day, it is a great way to establish a baseline of nutrition. These are hypoallergenic and made in the USA.

Fertility Friend
My favorite app, website, and community support system for women to understand and track their menstrual cycles. There are tutorials on how to chart, factors that impact cycle regularity, and expected signs and symptoms. The majority of the site is free, and they offer a VIP subscription for a few extra bells and whistles that you may or may not be interested in.

emWave Biofeedback
This is an amazing daily tool to help train you to bring the mind and body into cohearence.  It is best used in conjunction with a health professional to learn the basics, track your progress, and troubleshoot issues.  For those with stress, anxiety, panic, or emotional lability, you can learn to control your reactions by staying calm and present in the moment. It may be part of a self-improvement plan or used in conjunction with other therapies to manage mood and anxiety disorders.

Acupuncture for Improving Health and Well-Being

Jing was recently featured on our local news, WDRB 41 Louisville. We were able to demonstrate acupuncture as well as non-needle modalities such as cupping, moxibustion, Tui-Na, and magnet therapy. Somehow the crew managed to make 4:30am fun! Check out the series of videos here: Acupuncture for improving health and well-being - WDRB 41 Louisville - News, Weather, Sports Community

Keith Kaiser having fun with an auricular  acupuncture model

Acupuncture shoulder points

Cupping 

Stress: One Point Can Make The Difference

There are hundreds of acupuncture points throughout the body, but there are some that elicit a particularly powerful therapeutic response.   The following studies explain the method of actions of two different points and examines the beneficial effects that using just one point can have on chronic stress.

Stomach 36
In this study from Georgetown University, researchers administered electroacupuncture to acupuncture point St36 to the treatment group, sham acupuncture to another group, and no acupuncture to the control group prior to and following a stressor.  They exposed  all of the groups to fourteen days in a cold environment in order to induce a physiologic stress response. The sympathetic peptide, neuropeptide Y (NPY), elevated levels of which are found in those suffering from PTSD or other chronic stress conditions, and is hypothesized to contribute to the physiological stress response. No difference in NPY levels was found in the sham and control groups. The treatment group saw immediate and sustained suppression of NPY indicating that acupuncture to St36 may be an effective treatment and prevention of chronic stress.

Acupuncture at ST36 prevents chronic stress-induced increases in neuropeptide Y in rat. Eshkevari L, Egan R, Phillips D, Tilan J, Carney E, Azzam N, Amri H, Mulroney S. Experimental Biology and Medicine. In press. (2011).

Pericardium 6
Building on previous studies that demonstrated the effectiveness of P6 to decrease stress-induced anxiety,  researchers in Korea investigated the effect of this acupuncture point on memory by measuring acetylcholinesterase (AchE) activity in the hippocampus.   Individuals with chronic, mild stress exhibit low levels of AchE and that can result in memory impairment. Those in the treatment group received three minutes of stimulation on P6 resulting in an increase in AchE reactivity that was not produced in those receiving stimulation at acupuncture point San Jiao 5.  Researchers concluded P6  is an effective point for restoring the CMS-related biochemical and behavioral impairments, such as learning and memory.

The effects of acupuncture (PC6) on chronic mild stress-induced memory loss. Hyunyoung Kima, Hyun-Jung Parkb, Hyun Soo Shimd, Seung-Moo Hanc, Dae-Hyun Hahmd, Hyejung Leed, Insop Shimd. Neuroscience Letters. Volume 488, Issue 3, 25 1-2011, p 225-228.

Primer on Happiness

This photo came to me in a Facebook feed and I thought it would help set the appropriate tone as we reflect back on 2011 and create our mindset for 2012. Happy New Year!

Quick Coherence for Holiday Peace

We have been using a lot of Biofeedback for soldiers with PTSD to decrease anxiety and increase mindfulness. I am currently in the process of reviewing the emWave by HeartMath to determine if it is a good fit to use and recommend at Jing, and one of the initial practices suggested is a short heart meditation that does not require the aid of a device. Detailed information is available on their website along with a number of free tools and research. Try out this quick, proactive practice for your own centered presence before taking on holiday traffic or that pesky family drama!


Step 1: Focus
Bring awareness to the area around your heart in the center of your chest.  Place your hand over your sternum to help maintain this focus.

Step 2: Breath
Begin by taking your normal breaths gradually deepening each inhale and elongating each exhale. Imagine each inhale and exhale originates and flows freely from your heart center. Continue this practice until the breath feels natural and relaxed.

Step 3: Feeling
As you maintain your heart focus and breath, recall a positive memory or pleasurable feeling. Try to re-experience that moment, taking in all of the enjoyable sensory and interpersonal aspects that bring joy and peace. Linger here, allowing yourself to rebalance and recharge before moving forward.

Top 5 Self-Care Experiences of 2011

Many patients ask me what I do for my own self-care regimen - after all, if you are going to preach it, you need to practice it. One of my main sources of R&R are spa adventures both for my own personal enjoyment, but also as a way to research a variety of therapies to recommend as part of a total individual treatment plan for my patients. This year I had the opportunity to try several modalities in various locations  across the country, and the following are my reflections on those experiences.

Maya Abdominal Massage - I have only had one "full body" massage in my life where abdominal work was part of the treatment.  I have asked a number of massage therapists why, and answers range from "nobody likes it" to "we didn't learn that in school."  I agree, it feels a little weird partially because it is natural to guard the area, but also because most of us are not used to being so aware of our liver, stomach, or ileocecal valve.  Maya abdominal massage requires additional training and involves the entire core. This therapy addresses issues including pelvic discomfort (including hips and low back), sexual function, and gastrointestinal irregularity. My favorite place in Louisville is Balance in Motion.

Ashiatsu - I had this done while at a conference in Orlando at Rosen Shingle Creek Spa. This is an intense deep tissue massage where the therapist stands over holding parallel bars for balance and uses feet instead of finger pressure to target common trigger or acupuncture points.  This is sometimes called Oriental Bar Therapy and has become more popular in recent years. Deeper does not mean better or more effective and is not an appropriate therapy for everyone. Folks who have a lot of scar tissue or adhesions may like this therapy, however those with fibromyalgia or myofacial syndrome may find it makes their condition worse.

Reflexology - Perhaps my favorite treatment when done by someone formally trained, I have yet to get through one of these without falling asleep! More than a foot, hand, or ear massage, this modality uses sustained finger-pressure techniques to find areas of the body in need of attention without having to touch them directly. This is a great alternative to full-body massage for those who have discomfort but prefer to remain clothed. Those who tend to do well with this therapy can often tell when the therapist is touching the neck area of the hands or sinus area of the foot.  I have had this done at Mandara spas in Orlando and Anaheim, Rachel's Salon in Memphis, Gould's Salon at the Peabody Memphis, and locally at my favorite place, J.R.s Salon.

Hot Stone - This is the number-one patient favorite, even in the summer and for those experiencing hot flashes! It is fantastic for people who like light-medium pressure with the goal of increasing circulation and relaxation. The stones are usually warm but some therapists will incorporate cold stones if appropriate.  The stones warm and relax the muscles to allow deeper but less intense work with hands with less post-treatment soreness than with other types of massage. I am lucky enough to have a very talented therapist at Jing who also brings aromatherapy and a foot scrub into the session. Genevieve's Healing Arts

Body Wraps - I get questions about these from folks who want to "detox" after surgery, as a seasonal cleanse, or to remove excess water weight. Those who like it enjoy the warm, cocoon feeling, improved circulation, and skin softening or tightening effects. Again, this is a good therapy for people who like to spa, but may be touch-sensative.  To be honest though,  I do not like the feeling of being swaddled in plastic wrap and wet towels saturated by algae powder and my own sweat. I have had about three of these in my whole life and all were a bit different, but nonetheless, not for me.

***Disclaimer: None of these companies listed provided compensation for reviewing their services

A little Monday Morning Advocacy from the Coalition for Safe Acupuncture Practice

I received this in an email newsletter this morning and I believe it is important to get this information out. While crossover practice exists in multiple western medicine disciplines, proof equivalent training is always part of the equation. I have long maintained there is a problem with MDs, DOs, DPTs, and DCs being able to take a quick (if any) course of acupuncture and have it fold into their scope of practice. Stating that techniques like dry needling are not TCM and therefor do not require TCM theory is fine, however there is ample training in technique and clinical supervision that is necessary regardless of the guiding theory. By that rational, anyone who draws blood, administers injections, pierces body parts, gives tattoos, or otherwise has a needle meeting skin as part of their discipline should be eligible to take a course for a few hours and hand their shingle. If that does not sound like a good idea, neither should this . . . 

Please join us in responding to Dry Needling...  

Dry Needling for Pain Management, as developed by Yun-Tao Ma, PhD., is a 24 classroom hour work-shop designed for Physical Therapists who wish to use Dry Needling in their patient practice. After completion of Dry Needling for Pain Management, Physical Therapists are encouraged to insert needles into their patients as part of their treatment protocols. Dry Needling is,by definition, the insertion of solid, acupuncture-type needles into body tissue. Dry Needling technique is acupuncture technique.  

Training in Dry Needling, as provided to Physical Therapists, does not include the 6 hour Clean Needle Technique safety course and Clean Needle certification exam that all Acupuncture students must complete and pass. Training in Dry Needling, as provided to Physical Therapists, does not include the 150 hours of clinical observation plus 118 hours of needling technique classroom instruction required of all Acupuncture students prior to beginning their clinical internships. Training in Dry Needling, as provided to Physical Therapists, does not include the Illinois state mandated additional 660 hours of needling and acupuncture technique practice that all present Acupuncture students must complete while being supervised by Illinois State licensed acupuncturists at an ACAMO-accredited and Illinois state approved educational institution.  

The Coalition for Safe Acupuncture Practice (CSAP) seeks to bring attention to the inadequacy of clinical, classroom and Clean Needle Technique instruction received by Physical Therapists who are using Dry Needling in their treatment practices. Please read the CSAP mission statement at end and consider joining us so that we may bring social awareness to this public health issue.

CCAOM Position Paper on Dry Needling 

American Association of Acupuncture and Oriental Medicine Position Statement of Acupuncture Trigger Point Dry Needling and Intramuscular Manuel Therapy 

‎"Melting You Icebergs"

A Facebook professional contact posted this recently and I thought it was worth sharing because, chances are, you are reading this on a computer and susceptible to frozen icebergs!  

Shoulders.

You keyboard right?  

Midway between the far end of your shoulder and your spine there is a gathering point for stress. It feels both good and bad whenever someone presses on it. 1 iceburg on each shoulder. Not quite as bad as Atlas.  So let's melt them.

Push your shoulders up to your ears or as far as they will go. Then let them fall slowly and SOFTEN. Think of hot butter. Think of ice melting. Move your right hand to your left shoulder and gently GRAB that point and squeeze, not like you are wrestling with an enemy, but like you are embracing a wounded loved one. With care. And work out sone of that tender stiffness. Do the same with the other hand and shoulder.  Then make some really REALLY BIG circles with your shoulders. All the way up back down forward, and around and around.  

W O R K I T O U T.

Now step away from your computer and do something else for a while. Take care of you!

Engage With Grace

Death. The big "D" word. We only die once, yet the subject is often taboo to discuss even when terminal illness or unexpected event occurs. Just as preventative healthcare is preferable to interventional disease care, having these kinds of discussions are important not just for the one who is dying, but for those who are left to grieve. Many acupuncturists provide palliative care both for the individual and their families and can play a role in facilitating these discussions. When you and your family know the answers to the following questions, the burden of decision-making and potential for conflict in the midst of grief and shock is greatly lessened. This movement is just as important for those in the bed as it is for those standing by it. Please pass it on!

Engage With Grace/The One Slide Project

Acupuncture's Method of Action: Adenosine (?)

"A patient's report of pain is to be believed." This basic assessment is taught to all aspiring healthcare providers. Their report of pain relief, however, is often accepted only if there is a scientific explanation. Acupuncture is constantly being called quack medicine with all of it's "Qi" and "meridian" hocus-pocus, while patients who support it's efficacy cajoled for being so simple or desperate that they experience nothing more than a placebo effect.  Thanks to an ever-expanding body of research, we may start referring to "Qi" as both energy and chemical transmission.

Researchers from the Center for Translational Neuromedicine in Rochester now offer another plausible scientific explanation for the analgesic effect of acupuncture. A study on peripheral nervous system pain in animals found acupuncture increases formation of adenosine, a nucleoside that produces anti-inflammatory and pain-relieving effect.  Although deeper insertion and stimulation produced a greater effect, a moderate increase in adenosine may be observed with application of pressure, heat, or vibration to this skin.  This may also explain why non-invasive "sham" acupuncture treatments can elicit a therapeutic effect, but also why these benefits do not endure over the course of follow-up. Previous studies focused on the central nervous system determined acupuncture also stimulates the release of endorphins in the brain. Bring on the science!

For the full article, visit Nature Neuroscience

Pain Relief for Veterans

For several years, the military has recognized the benefit of incorporating acupuncture therapy in a holistic treatment plan for PTSD and substance abuse issues, even if they generally do not used trained, qualified, and licensed acupuncturists to perform it. As miffed as I am that they allow the "jab-and-go" providers instead of hiring people with an actual degree in the medicine (yes, I am jealous . . . and available for collaboration), at least they recognize the contribution of the modality. Our soldiers and veterans are returning with some interesting autoimmune and auto-inflammatory diseases at a rate higher than the general population. Rheumatoid arthritis,  scleroderma, pernicious anemia, chronic recurrent multifocal osteomylitis - whether contracted by inhaling burning trash, as result of traumatic-brain injury, excessive vaccination (double vaccination in the cases where they lost a soldiers records "just in case") or physical manifestation of a psychological malady, there is no denying many of our vets are in physical and emotional pain. And so, I put aside my professional irritation and offer nothing but praise for using acupuncture as an adjunct for pain control in our wounded warriors.

Army looks toward new ways to fight the pain

Soldiers are getting alternative medicine.

By Sig Christenson
sigc@express-news.net

Published 01:55 a.m., Monday, September 26, 2011

Sgt. 1st Class Jennifer Wright used to jog, walk, lift weights and ride her Harley-Davidson Fat Boy, the motorcycle she bought after serving in Iraq.

Today, she's among a growing legion of war veterans suffering from scleroderma, a painful and potentially fatal disease. Wright, 40, feels pain in her face, joints and toes. She's lost some of her hair, and her toenails fell off.

“It's to the point I want them to deaden the nerves in my face. But (the doctor) said if you do that you take a chance of developing muscle atrophy, Bell's palsy with the real bad facial droop, no muscle control,” she said. “I said I'm willing to take my chances. Just do something about it. It's just consumed me, and I'm miserable.”

Pain pills are part of the treatment, but in her case they don't last long, so an orthopedic physician's assistant last week performed an acupuncture treatment, injecting small gold needles into selected parts of her ear.

Her care is part of the Army's fledgling complementary alternative medicine program, which is testing new therapies, some of them unproven and one literally out of this world.

It's another option for GIs who have returned from combat with pain from a variety of wounds and illnesses, for whom the Army has spent billions on drugs that have resulted in complications, dependency, abuse and even accidental deaths and suicides.

Read more 

Providers Treating Providers

The past several days I noticed many people posting about a study reporting the increasing popularity of acupuncture and other CAM among healthcare providers over the general population. Shock? Nope. I see my fair share of MDs, RNs, NPs, DPTs, PharmDs, LMTs and folks who work in the healthcare administrative arenas. They, more than anyone else, see the end effects of poorly managed chronic illness and reactive rather than proactive self-care. Contrary to popular opinion, they often make the best patients . . . and even joke about how bummed out they are that this stuff actually works!

My only gripe with the CAM classifications in the study is they include self-administered therapies like nutrition (which is an alternative to what, exactly, starving?) and exercises like pilates and yoga. I do not think anything that is diet, exercise, or rest related is complementary or alternative - you either do those things or you drop dead of something. Overall it was well done and I am glad to see an increase in acceptance that a patient's report of relief is a reliable resource, with or without an impressive postscript after their name!

Discussion Excerpt:


This study provides the first population-based description of CAM use by U.S. health care workers. Our analyses reveal that, overall, health care workers are significantly more likely to use CAM therapies, particularly mind-body therapies, than the employed U.S. population. This is not surprising as health care workers, particularly those in ambulatory care settings, are more exposed to these methods, and exposure is probably correlated with higher use. Our results are also consistent with findings of previous studies documenting a high prevalence of CAM use in narrowly defined health care worker populations. For example, one study found that 63 percent of nurse practitioners in Connecticut reported personal use of CAM (Hayes and Alexander 2000), whereas another reported 96 percent of critical care nurses across the United States had personal experience with CAM (Lindquist, Tracy, and Savik 2003). Studies of physicians reveal a lower prevalence of personal CAM use. One study reported that 24 percent of physicians in Denver had personally used CAM (Corbin Winslow and Shapiro 2002), whereas another found that 49 percent of primary care clinicians in Kentucky reported personal use of CAM in the past year (Flannery et al. 2006). A high percentage of health professions faculty report CAM use, with 83 percent of primary care faculty at one medical school having ever used CAM (Levine, Weber-Levine, and Mayberry 2003) and 100 percent of nursing faculty in another university having personally used a CAM therapy (Halcon et al. 2003).


Read More
Johnson, P. J., Ward, A., Knutson, L. and Sendelbach, S. (2011), Personal Use of Complementary and Alternative Medicine (CAM) by U.S. Health Care Workers. Health Services Research. doi: 10.1111/j.1475-6773.2011.01304.x

Engineering Explanations

Lately I have noticed my usual answers to the common questions "how does acupuncture work? I mean, what do the needles really do?" have not been working for the folks who want an explanation in 20 words or less. Although I provide excellent literature on theory, a few months ago I jettisoned my TCM explanation and shortened it to "the needle sensation helps direct the release and flow of endorphins to stimulate the body's self-healing processes." This seems to satisfy those who find things like Qi and meridians either too esoteric or too hippy dippy to accept as viable healthcare.

As it turns out, my simple explanation has evidence-based research to back it. The Columbia University electrical engineering department and University of Hong Kong medical faculty of the collaborated on a study published in the June 2011 issue of The European Journal of Physiology to explain how acupuncture works. Needling acupuncture points sends slow-moving acoustic waves into the muscles. This triggers a flow of calcium that interacts with white blood cells and produces endorphins which can relieve pain and nausea throughout the body. Accuracy and point selection are important. Correct placement generates a 6-8 centimeter wave whereas incorrect placement up to 1 centimeter generates only a 3-4 centimeter wave. This finding may help explain why sham acupuncture can have a therapeutic effect even if delivered via toothpick (as I have been saying as nauseam!).

Here is the abstract:
This article presents a novel model of acupuncture physiology based on cellular calcium activation by an acoustic shear wave (ASW) generated by the mechanical movement of the needle. An acupuncture needle was driven by a piezoelectric transducer at 100 Hz or below, and the ASW in human calf was imaged by magnetic resonance elastography. At the cell level, the ASW activated intracellular Ca2+ transients and oscillations in fibroblasts and endothelial, ventricular myocytes and neuronal PC-12 cells along with frequency–amplitude tuning and memory capabilities. Monitoring in vivo mammalian experiments with ASW, enhancement of endorphin in blood plasma and blocking by Gd3+ were observed; and increased Ca2+ fluorescence in mouse hind leg muscle was imaged by two-photon microscopy. In contrast with traditional acupuncture models, the signal source is derived from the total acoustic energy. ASW signaling makes use of the anisotropy of elasticity of tissues as its waveguides for transmission and that cell activation is not based on the nervous system.

Link to Study
10.1007/s00424-011-0993-7

The "Other" Provider: It's Time to Talk

Despite most intake forms including a section for vitamin, supplements, and other therapies, many people keep complementary and alternative treatments from their primary care provider. Sometimes this is because of a lack of knowledge that a particular health behavior is an actual therapy, that it has the potential to interfere with conventional treatment, or that it should be reported. Providers neglecting to ask,  lack of time to bring up the topic, and concern of provider disapproval or embarrassment over what they might think also contribute to underreporting. Although we are moving to a partnership model of healthcare, many of those in the "greatest," "boomer," and even "X" generations in the US are more comfortable with the paternalistic paradigm. The National Center for Complementary and Alternative Medicine, a division of the National Institute of Health, launched a program called "Time to Talk" for providers, patients, and organizations to foster communication and improve care coordination. The site provides a variety of material to help get the discussion started. I am especially impressed that it reassures providers they are not expected to be CAM experts and encourages them to refer patients to available evidence-based education materials rather than, as I have seen, run into their office to Google an herb or supplement to fein expertise.

Check out the program at Time To Talk

What People 50 and Older are Using and Discussing with Their Physicians

"Will Acupuncture Work for Me?"

The July/August 2011 issue of the Clinical Journal of Pain includes a German randomized-control study investigating potential patient characteristics that could predict positive outcomes to acupuncture for the treatment of chronic pain. Nearly 10,000 individuals were included in the study, all of whom received routine standard therapies with half receiving acupuncture over a three-month period. Although not statistically significant, the acupuncture group showed greater pain relief than the routine treatment only group. Potential predictors of positive outcomes include living in a multi-person household, former positive experience with acupuncture, female gender, and failure of other therapies.

These results support the contention that acupuncture, like many other therapies, is a helpful modality that may work better in some people than in others, Naturally, more studies are necessary to further investigate potential effect modifiers, however there is no strong evidence that you have to believe in acupuncture for it to work or that a practitioner can tell acupuncture is going to work for an individual based solely on their demographics and health history.

Research: Acupuncture and Moxibustion for IBS

An article examining treatment modalities for irritable bowel syndrome revealed acupuncture is promising as a stand-alone or adjunct therapy. In all of the studies below, improvement was demonstrated by adding or using acupuncture to treat IBS symptoms. Although sham groups also showed improvement, I do not agree with the authors that this means it is all an "in-your-head" placebo effect, especially as the last study cited showed the best improvement came from a combination of acupuncture and moxibustion therapy. Many "sham" controls elicit a therapeutic effect because all forms of acupuncture release endorphins, but the effect is more masking than curative. Long-term relief comparison studies between sham and true acupuncture are remarkably absent in the literature and are necessary to dispel the notion that you can stick a needle anywhere and get the same outcome.  Additionally, there is no "standardized" acupuncture treatment protocol for IBS because acupuncture uses pattern discrimination, not medical diagnosis, to determine individual treatment plans. 


Excerpt from the June 2011 issue of Alternative Medicine Review:

Acupuncture and Moxibustion
Acupuncture can cause physiological changes that affect various endogenous neurotransmitter systems. Of specific interest to the treatment of IBS is the influence of acupuncture and moxibustion on the serotonergic and cholinergic neurotransmission of the brain-gut axis. Both animal and human trials indicate specific targets for acupuncture on serotonergic, cholinergic, and glutamatergic pathways as well as reductions in blood Cortisol levels.

In a controlled, randomized pilot study, 30 subjects received routine clinical care or acupuncture for IBS. After three months of treatment, outcomes of acupuncture intervention revealed statistically and clinically significant improvements in symptom severity, including pain, distension, bowel habits, and QOL compared to usual care only. In this study, however, the type of IBS was not defined for the sample population.

In a large, randomized, controlled study, 230 subjects with IBS were assigned to one of three groups. The two intervention groups were either three weeks of true or sham acupuncture following a three-week run-in period of sham acupuncture therapy with a "limited" (friendly, interactive) patient-practitioner relationship, while the third arm was a waitlist control group. Findings indicated no significant difference in global outcome measurements between real and sham acupuncture, but both interventions showed significant improvement over the waitlist control group.

In another similar study, Schneider and colleagues randomized 43 subjects to receive either
acupuncture or sham acupuncture for 10 sessions(an average of two per week). Although the Functional Diseases QOL questionnaire (FDDQL) in this study revealed that both groups improved significantly in overall QOL, there was no difference between the two groups, suggesting that the effect of acupuncture was primarily a placebo response.

According to Anastasi and colleagues, a combination of acupuncture and moxibustion (acu/moxa)can be highly effective in IBS treatment. Twenty-nine subjects who met Rome II criteria were randomized into either individualized acu/moxa treatments or sham/placebo acu/moxa treatments. Results indicated that acu/moxa reduced abdominal pain, significantly reduced gas and bloating, and improved stool consistency over a four-week, eight-session intervention period. A Cochrane meta-analysis suggests larger-scale studies are warranted to confirm the benefits of acu/moxa in alleviating IBS symptoms.