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Moderator: I'm Marty Moss-Coane. Welcome to ourWebcast. Acupuncture is an ancient Chinese tradition that goes back thousands of years and for people who are used to a western approach to health and illness, its philosophy and practice can sound very alien. Practitioners place special needles in specific parts of the body, which reportedly can relieve the symptoms and problems like headaches, allergies, and respiratory ailments. It can even act as a form of anesthesia. There is a growing interest in acupuncture, but how much do health consumers really know about what happens in an acupuncturist's office? What illnesses and injuries can respond best to acupuncture and what are its limitations? We'll address all that with our guests.
Elizabeth Call is a licensed acupuncturist in private practice. She is also the Dean of Clinical Training at Tri-State College of Acupuncture in New York City. Nice to have you with us. And Dr. Ravinder Mamtani is a Professor of Clinical Preventive Medicine, Medical Director of the Occupational Health Center at New York Medical College, Westchester Medical Center in Valhalla, New York. He is also the Director of Complementary Medicine Services and Director of courses in acupuncture and homeopathy at New York Medical College. Ravi, nice to have you with us as well.
Well, let's begin. Let's say I come to your office and I've been experiencing a week's worth of fairly severe stress-related headaches. What are some of the questions that you might ask me as I sit down trying to figure out whether I want to have acupuncture or not? What would you want to know about me?
Ms. EC: Well first I might want to know how long you've been having them. I might want to know what your general bodily functions are. In acupuncture we have ten questions and we ask about sleep, we ask about appetite, we ask the nature and the location of the pain, and we also ask about general health habits, such as elimination and urination, that sort of thing.
Moderator: And, would you want to examine, you know, look in my mouth, look in my ears, and take my blood pressure, things like that?
Dr. RM: Yes. I think I will certainly look at it from a different standpoint. I'm a physician, so I'm sensitive to the fact that I'm a physician and I want to take care of my patients from a conventional standpoint as well. So, a patient in a situation like that will be evaluated in terms of the chief complaint, the past history, the social history, the family history, a proper conventional examination and testing that may be required to understand the cause of headache or migraine. And, having done that, certainly, if this is something that is correctable by means of surgery, in a conventional situation, you might want to recommend that to your patient. If on the other hand, you've been able to rule out other causes --- organic causes --- and if you've come to the conclusion that this is related to stress or migraine, then certainly it would be appropriate to bring in acupuncture as a complementary modality and offer it to your patients. And when you do that, you want to share with your patients the pros and cons of the procedure, and so that would be my approach in conjunction with what Elizabeth said.
Moderator: Is it important to look at the tongue? Is that an indicator of health or illness?
Ms. EC: Well, the next step after ‘asking' is going to be ‘looking and touching'. So, I'm going to look at the tongue. I also look at the face, look at the body, the general body. Then, I also, I might do abdominal evaluation. That's a traditional evaluation. I'll also palpate points. I'll also palpate the wrist pulses and again, look at the tongue and look at a pattern --- what we call a pattern of disharmony --- or a functional tendency towards stagnation. And then I would treat that.
Moderator: What are you looking for in the tongue?
Ms. EC: I'm looking for color --- the color of the body, the color of the coat, the lack of a coat or whether there is the presence of a coat, look at cracks, look at whether it shakes or not, the size, the overall shape of the tongue.
Moderator: Do you look at the tongue?
Dr. RM: Yes, absolutely. And, I think it is important that if you are doing acupuncture that one keeps in mind the founding theories of acupuncture and certainly that would be done. I think the purpose would be to make a distinction, for example, between what is called a yin presentation as opposed to yang, and then do your stimulation based on that.
Moderator: What do you think acupuncture is most effective for? What have you found from your own experience?
Dr. RM: Well, I think that the one group of disorders would be the pain-producing disorders.
Moderator: Such as?
Dr. RM: Such as neck pain, low back pain, other joint pains, muscle pains, and so on and so forth. Then, the second group, related to that, is headaches and migraines. The third group of disorders is related to substance abuse problems --- addiction to cocaine, heroin and also smoking, nicotine addiction. For problems related to women's health such as PMS, menopausal symptoms, for gastrointestinal problems such as nausea associated with chemotherapy for example, and anesthesia, also in stroke rehabilitation and for the treatment of respiratory conditions such as bronchial asthma and allergies. Now that's a listing of conditions for which there is enough scientific randomized controlled trial evidence. But I'm sure Elizabeth can add other conditions to that list as well.
Moderator: Does that pretty much cover it?
Ms. EC: Yeah.
Moderator: The converse question is then --- Where do you think acupuncture doesn't work? And then I'd like to take some of these e-mail questions here. Where do you think it really isn't an appropriate treatment?
Ms. EC: I think any condition in which there are major tissue changes, I mean very, very… structural damage or major structural changes. For example, I don't treat cancer. There are major tissue changes going on there. However, I do treat the nausea associated with chemotherapy very frequently in my practice, as most acupuncturists do. So, that's how it can complement western medicine. Receiving acupuncture treatments for the nausea, and to increase the functional abilities of the patient, for example, would round out the treatment that someone gets for cancer.
Moderator: That makes sense.
Dr. RM: Sure. And I can, perhaps, exemplify that by giving you a real example. I had a lady who came to my office who complained of pain in the groin region and wanted acupuncture for the pain. As I spoke to her, I discovered that this pain was related to a urinary tract infection. I therefore, told her that it would be appropriate that she go back to her primary physician and who, I think in all likelihood, will give her a prescription for an antibiotic, that will really take care of her infection. And that's exactly what happened. I received a nice little note from her thanking me for not doing acupuncture in a situation where there were other conventional means to take care of her problems --- As an example of the point you made.
Ms. EC: Well, another thing I would like to point out is that often, when chronic urinary tract infections that are not responding to antibiotics, possibly because of the overuse of antibiotics, it can respond to treatments like acupuncture, sometimes supplemented with other modalities, other treatments.
Moderator: Well let's take some e-mail. We have a fair number of them. This is from Marcia from Wilmington, North Carolina. She says, ‘I have the following problems. On the right side, femoral neuropathy, pain weakness, sciatica, SI pain. Can acupuncture help treat the neuropathy and the other problems?' And we always have to say this on the program, which is, obviously, you need to get a direct answer to these questions from someone in the medical field. But, generally speaking, do you find that acupuncture would help?
Ms. EC: Well, that type of presentation is very common. If it is not complicated, again, by structural changes it can respond very quickly to acupuncture. If there is a disk bulging, or other type of change in the body, it might take longer and the person may need physical therapy, as well as other types of conventional treatments.
Moderator: You mean in conjunction with something like acupuncture?
Dr. RM: I would tend to agree and I would add to that. In a situation like this, and in many other clinical situations that I see in my practice, I think the goal of acupuncture treatments is to provide symptomatic assistance and improve the quality of life of patients. I don't think most of us will promise “cures”, if you will, but just that there isan option available to patients who can help them improve their quality of life.
Moderator: This is an e-mail from Lynn from Auburn New Hampshire. ‘How can acupuncture help me to quit taking sleeping medication at bedtime? Without it I am up all night.' Have you found that it can be helpful in helping someone go to sleep?
Ms. EC: Well, let me just say this. Getting someone off sleeping medication is not easy because already there is the rebound symptoms, the withdrawal symptoms and they would probably need to get treatment fairly frequently in order to deal with that. But if they are willing to cut down, do a step-down approach in conjunction with their physician, so that their physician is kind of monitoring that, acupuncture could help them.
Dr. RM: Yes, I would tend to agree. But, I would also like to say that I think a comprehensive approach to evaluation and management might be appropriate. What I mean by this is you really must understand what are the causes of insomnia in this patient. While you are doing this, certainly to complement with that some acupuncture treatments to be able to help a patient.
Moderator: Yeah and I just should say to Lynn that we've done a number of programs on sleep disorders, which she might want to check out. This is from someone …it. Looks like the same person from Auburn, New Hampshire. ‘How does acupuncture help with hot flashes? I was thrown into menopause from chemotherapy to treat Stage 2A breast cancer.' But talking about hot flashes associated with menopause is acupuncture helpful in that problem?
Dr. RM: I have had some patients who have benefited from acupuncture with symptoms of that nature. I might add that there are a certain number of patients who don't respond to acupuncture within the usual protocol of 8 to 10 treatments and I think it is fair that the physician or a licensed acupuncturist discusses that with the patient. That is not to say that adding additional treatments will not be helpful. But I think we have an obligation to keep our patients informed in terms of what is the usual protocol and that there is a certain percentage of patients who do not respond to acupuncture.
Moderator: I wonder how many sessions you have to have before you know acupuncture isn't working?
Dr. RM: There is a standard, if you will, that is beginning to emerge and Elizabeth can comment on that. A fair trial of acupuncture is somewhere in the region of 8 to 10 treatments on average done maybe between one and three treatments a week. And, if after receiving those treatments one does not respond, maybe you have a patient who might possibly be a non-responder to acupuncture.
Ms. EC: Or, in my case you might want to have more medical work-up. Most of my patients have had extensive medical work-up. Occasionally, I have people that haven't had it, but their doctors agreed to start conservatively and they wanted to try acupuncture first, and so that's what we did. And, occasionally I have someone who slows to respond or it doesn't seem to be sticking, so to speak, then I recommend that they go back to their physician and tell them. They may be a non-responder or they may need further medical looking.
Moderator: Do you find that people come to acupuncture with perhaps too high expectations, especially if you are dealing with some kind of chronic situation, thinking, oh now I'm really going to get the treatment that is going to fix this?
Ms. EC: You know early on in my practice, eight years ago, I did get that. Now, I think the public is more aware of it. But every once in a while I do have to really let someone know the course of treatment and the time frame in which I expect to see some kind of change.
Moderator: Give them a kind of a realistic picture to work with?
Dr. RM: I think so and you certainly want to inform them about acupuncture and have a discussion with them before using needles , I think is an important thing to do.
Moderator: Here's another e-mail from Seattle, Washington. ‘Will acupuncture cure facial hair growth? I'm suffering from this problem for more than six or seven years now. I tried electrolysis but got no relief.' So is there any remedy in acupuncture? Have you ever been aware of applying it under those circumstances?
Dr. RM: That's a difficult issue and I have personally not come across it in my practice, patients who've come to me for that specific reason I haven't treated anyone with that kind of problem. So, I am unable to comment on that question.
Ms. EC: I don't have any experience with that.
Moderator: Are there side affects associated with acupuncture? If you have several sessions of treatments, do you feel light-headed? Do you feel relaxed? Do you feel tingling? Giddy? What?
Dr. RM: I think there might be two ways of looking at side effects or complications, if you will. Some are benign and are transient in nature, such as dizziness, feeling light-headed --- they are not really serious. The serious complications that have occurred (and I was reviewing the literature just last week ,) haven't been that many. In about a 20-year period, it is my impression that about 200 to 300 complications have occurred. That's not that many as compared to complications that we see with conventional procedure and means. So, it's a relatively safe procedure. It's benign and I think, if appropriately used, can be successful in treating many patients.
Moderator: We have another e-mail. This is Deb from New York. Can acupuncture help arthritis? Elizabeth.
Ms. EC: I think it depends on the kind of arthritis. It depends on how long the person's had it and it depends on the level of their pain, and how severe the arthritis is. And, sometimes when there have been structural changes that occur in the joints, it sometimes is a little bit more difficult. But it's certainly worth looking into and trying a treatment maybe as an adjunct to other types of therapies as well.
Moderator: Well, this question reminds me of the fact that we are an aging population and more people living longer , and often times having to deal with chronic aches and pains. Have you found acupuncture is helpful in dealing with some of these expected aches and pains of aging?
Ms. EC: I do have some geriatric patients in my practice and they do respond very well and do appreciate the higher level of functioning that they can get. In some cases, the process of aging is going to be a little bit more difficult to work with but it can be very helpful for people.
Moderator: And gives them a little bit more mobility, perhaps a little less stress and pain, more options….
Ms. EC:.. Options in their life to work with?
Dr. RM: I think that in elderly people we are looking at the issue of chronic disease and, for the most part, resulting in chronic pain and I think acupuncture can play a very useful complementary role, as Elizabeth said. And again, with the goals of providing symptomatic assistance and improving their quality of life. So, I personally feel that there is definitely a very important role for the aging population.
Ms. EC: And also, too, I just wanted to point out that sometimes the elderly person is put on a lot of different drugs and sometimes there can be the possibility of drug interactions and usually, if you can use acupuncture to get them off some pain medication, in some cases sleeping medication, or even keep them from ever getting that type of medication It could be very helpful.
Moderator: A final question having to do with children. Do you use acupuncture with children? Is it the same treatment, same philosophy, same approach?
Ms. EC: Same philosophy, slightly altered treatment, slightly altered approach. Obviously, you want to use more shallow needling techniques. You have to work with the child, obviously, a lot more. And sometimes you do things like moxibustion. Sometimes you do things like acupressure, massage --- like Tui Na or A Ma massage, meridian massage --- sometimes children respond very well to that and then a few well-placed needles at the appropriate places.
Moderator: And in your 20 years with children?
Dr. RM: [LAUGHS] I would tend to agree with what Elizabeth said and I have found it to be most useful with older girls, especially for the PMS-related problems and stress-related issues. It is not customary for me to see pediatric population(s), but whatever little work I've done, it has a role to play.
Moderator: Well, I want to thank you both very much for talking about the various uses of acupuncture. Thank you. And thank you very much for joining us, I am Marty Moss-Coane. We'll be right back.
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