Foot Pain, Foot Function, & Shoes

My personal health issues, combined with frustration with lack of results using the current common answers, continually take me to new and interesting places. In the past year most of what I know about metabolism, nutrition, and now feet (and foot pain) has shifted drastically. It all comes back to evolution.

I’ve had intermittent stabbing pain for about 7 years, focused at the 1st MP joint (where the big toe joins the foot). I walk a lot, and the more I walked, the more it hurt. It had been diagnosed as a stress fracture years ago, and and for years I would wear Danskos* (hard soles, so my feet didn’t flex) when the pain got bad. Basically the Danskos acted as a walking boot. I am heavy (180lbs, due to muscle and bone from my bodybuilding days, plus all the extra padding I’m currently carrying) and have small feet and a stompy gait… It just refused to heal.

The foot pain had been interfering with my workouts, but it was getting worse and now messing with my weekend fun, too … that’s no good! So I started investigating and it turns out the solution was simple. I didn’t have a stress fracture at all.

diabetes_foot_problems_s13_hammertoesWearing tight shoes, especially heels, can cause bunions (angled big toe), neuromas, and hammertoes (bent toes), too. Fortunately my problem was easier to fix than the poor feet in this stock photo!

I had to change my shoes.

That wasn’t all of it, of course – I also needed some fascial adhesions stripped out. Acupuncture reduced the pain and swelling, and the minimal shoes I transitioned into have had the cool side-effect of forcing me to soften my gait. I wear CorrectToes spacers when I remember. Still, changing the shoes was key . Shopping guide here.

Rolfer Karin Edwards-Wagner does a lot of work with feet, and she pointed me towards the brilliant Dr. Ray McClanahan. He’s got a bunch of videos and articles on his site, so rather than reinventing the wheel I’ll just let you look at his stuff.

Here’s the deal: See those bones on the top of your foot? Your toes should extend in a straight line from them. For centuries we have crammed our feet into shoes that gathered the toes together, creating a sleeker pointed look instead of the spread “duck-foot” that nature intended.

Available here in the office, Correct Toes spacers help separate and flatten your toes into a natural spread for better stability. Use them along with changing your shoes, and getting some acupuncture and medical massage to break up fascial adhesions and relax the muscles of your feet. Your knees, hips, and even lower back will be happier once your gait is correct!

ct-before-during-after__smCorrectToesLogo_small

 

Under your big toes are tiny floating bones called sesamoid bones, which provide leverage and assist in tracking as a tendon moves over bone. The knee cap is a sesamoid, too – in fact you can imagine a miniature knee cap under that joint in your foot. The bones have grooves that the sesamoids are supposed to follow. If the toe angles inwards, the bone is pulled off track. Ouch!

The funny thing here is that my feet look pretty “normal.” I don’t have bunions or any obvious deformation… just a few degrees was enough to cause that foot pain for me. I haven’t worn heels for years. Even so, I had a huge pile of shoes and boots (some of them practically new) that I had to sell, donate, or toss. The trick is finding shoes that:

1)   Have flexible soles across the ball of the foot and also longitudinally, for twisting.

2)   Have the heel at the same level as the toe. Now that I’m used to “zero-drop” shoes, even a half-inch heel feels weird.

3)   Fit well in the heel and instep, but have lots of room in the toebox. This is why regular “wide” shoes don’t work for me – the rest of my foot isn’t wide. See the pic below.

4)   Don’t have a lot of  “toe spring” – that’s when the toe of the shoe comes up off the ground. It pushes you into an unnatural position all the time.

Standing (with all of your weight) on the bottoms of the soles of shoes is a good way to assess how much room you’ll have. For boots, you can take out the inserts and stand on those instead. If your favorite shoes are just a smidge too tight in the toe box, you can remove the inserts, which gives you a few more millimeters of room to stretch out.  If they are lace-up shoes, skipping the first set of holes can also let the toe box open up.

No more foot pain! See how the medial (inside) edge has a square-ish corner, instead of being rounded? Wide at the ball of the foot isn't enough - that big toe needs to be able to move and spread outwards. These are my new favorites, Clark's "Faraway Field," available in other colors if you aren't into blue suede shoes. :)

No more foot pain! See how the medial (inside) edge has a square-ish corner, instead of being rounded? Wide at the ball of the foot isn’t enough – that big toe needs to be able to move and spread outwards. These are my new favorites, Clark’s “Faraway Field,” available in other colors if you aren’t into blue suede shoes. :)

The sad truth is that most of the anatomically correct footwear out there is hideous, but I have found some cute options! Shopping info here. My winter boot review is here.

In addition to going shoe shopping, I also got some socks! The regular “mitten” sock can encourage toes to gather together, especially if they get pulled tight as you slip into your shoe.  When I wear those, I stretch out the toe seam to give myself some room. Sock Dreams is a fun local company that carries a variety of toe socks, and they ship for free.

Can’t give up the heels due to work or your fashionista status? Check out this article on ways to mitigate the effects of high heels. 

So… the real question is, did it work? My emphatic answer is YES! A week after switching, for the first time I finished a LARPing weekend without being in agony. My foot and knee may have grumbled a few times (I run for miles during these weekends) but that searing pain was gone. At the end, instead of waiting miserably for Robert to be done cleaning, I was out doing extra trash sweeps, because I felt that good!  Plus, at my next workout, I had to ask Brandie to throw extra weights on for the leg extensions and squat press, because the weight we were doing before suddenly felt ridiculously easy. Correcting my foot function helped my knee normalize, too, which is a bonus I hadn’t expected. It makes sense, though. If the toes can spread out and do their job creating stability, it takes a lot of pressure off the knees.

The next adventure is the perfect intersection of SCA / LARP / craftiness, and healthcare: I’m going to try making my own shoes!

 

*Setting aside the issue of the heel height for the moment, it’s true that Danskos and other hard clogs make it easier on your feet. The trouble is, they make it too easy. It was obvious once I thought about it…

When a patient comes in with a brace (on the wrist, knee, back, whatever), we always have this discussion: “Immediately after an injury, a little support is very helpful. As you heal, though, you need to wean off the brace. It’s good to wear it for sports, or challenging events, but not all the time. If you baby the muscles, they won’t work and get stronger, which is what you really need to heal. Eventually you should be brace-free.”

I’d been over-bracing my feet. *headdesk*

Wearing softer, more flexible shoes that allow / force my feet to get to work makes them stronger. Here’s a cool exercise you can do to strengthen your feet. I still prefer some shock absorption when walking on man-made surfaces like concrete, but for dirt and carpet I like to go more minimal. 

What about arch support? Modern shoes actually give us TOO much support, so our foot and leg muscles don’t work, and get weak. Remember we evolved without shoes. Our feet are designed to support us, given the chance. By doing foot exercises and gradually transitioning to more minimal shoes, your arch will support itself. This is awesome because it means your feet take a lot of the load back from the ankles, knees, and hips in terms of balancing. The whole body works better when strong and supple.

Now that I have spent some time opening my feet up, I love the thin toe-separated shoes like Vibram 5 fingers. Just ease into them… minimal footwear takes some transition if your feet have been over-supported in regular shoes. I have a pair of Filas that are similar (just have shorter toes, so they fit me better) and I adore them! They are phenomenal for running around in the woods.

EDIT 7/1/13: Here’s an awesome article on another reason to wear good shoes – neurological challenge! Also – I get asked about foot pain due to Morton’s neuromas and plantar fasciitis (inflamed fascia) a lot. YES, I can treat them! The good news is that the treatment is immediately and highly effective. The bad news is that it’s the only treatment I do that hurts… Sorry. But only briefly, and it’s worth it, speaking personally!

Trusted Referrals & Healthy Shoe Shopping

Here’s a short list of professionals I recommend. Please let me know if you use one of these referrals – I’d love to hear how it goes for you!

Also – the second half is a guide to shopping for healthy shoes.

Physical Therapy:
New Heights
Locations in Vancouver, SE Portland, and NW Portland

Podiatrist: Dr. Ray McClanahan
Northwest Foot & Ankle
2701 NW Vaughn Street, Suite 424
Portland, OR 97209
(503) 243-2699

Personal Trainer:
Brandie Sylfae
(503) 422-0402

Rolfer:
Karin Edwards-Wagner
2732 SE 18th Ave Portland, OR 97202
(503) 230-0087

Massage:
Sally Leonard
Forget Me Knots
12655 SE Center St, Ste 530, Beaverton 97005
Yes, she’s in my office!
503-201-7110

Artisan Extraordinaire:
Custom clothing and enamel jewelry
L.A. Fine
acorncottageartisanry@gmail.com
(503) 285-4017

Clark Original on the left. The Jafe on the right is too stiff to be ideal for regular wear, but a rare find for fancy dress-up occasions.

Clark’s Original “Faraway Field” on the left, grey with mint stitching, also available in red, black, and brown. The Jafe on the right is too stiff to be ideal for regular wear, but works as a rare heel-less find for fancy dress-up occasions. Edited to add: The Jafe’s softened up with use, and the Clark’s model comes in more colors now! I just got myself some blue suede shoes!

Buying bio-mechanically correct shoes:
First, read this article about foot function and how to assess a shoe. Then, look for brands like Born, Clark’s, Keen, Lems, Jambu & J-41 (sexy sandals!), Vivo, Altra, Jafe, and Merrell. FiveFinger and Fila make minimal, separated toe shoes (personally, my short toes like the Filas much better – and they were a mere $30 at Big 5 sports!). Please note that I am NOT endorsing every model shoe the above brands make. For example, Keen has two footbeds, a stiff, narrow version (skip these!) and the one I like with the wide toebox.  In all brands, some models may be great, but others are too pointy-toed, too stiff, or have a heel. Shop carefully. When trying shoes on, you need to step on the insole itself and examine other factors discussed here. Try not to get carried away with something cute or a pair that feels “good enough” – your feet will get pickier as they adapt to having room to move! They will also spread out, so if you are between sizes, go up. Most people gain a half to a full size as their toes spread out. Winter boot guide here.

A happy surprise for the Pacific NW Fall weather - Bogs rainboots have no heel and give plenty of room for the front of the foot. I got my pair at Clogs & More on Hawthorne.

A happy surprise for the Pacific NW weather – Bogs rainboots have no heel and give plenty of room for the front of the foot. I got my pair at Clogs & More on Hawthorne.

Places to get biomechanically-correct footwear locally:

REI (surely you know where REI is)
FitRight NW  (they carry Lems) off NW 23rd
Pie in the Alberta district
Cobbler Bill’s near 82nd & Foster
Shoe Mill at the big malls
The Walking Company also in malls
Clogs N More – note – don’t buy clogs! :) Hawthorne and downtown
Imelda’s on Hawthorne
Footwise on Broadway

And don’t forget the toe socks so you can move freely inside your spiffy new shoes. Sock Dreams has a store in Sellwood, or you can order online. They carry unique, high quality stuff, including the elusive toesock with formed heels. They thoroughly describe their stock on the website, including measurement info like calf size. They ship superfast, for free, and, if you ask, they will do an ADORABLE drawing on your receipt.

Places to get biomechanically-correct footwear online:

soft-star-products

Part of the Soft Star shoe line. You can custom order your color choices!Ahimsa

Ahinsa Casual style, fabric shoes
Altra  Wide toebox running shoes
Belleville Military & law enforcement-type boots.
Lems ugly but comfortable
Oesh Variety of women’s styles from professional to casual.
Shoes for Crews Steeltoes, other serious work shoes & boots
Skidbusters Nursing, etc.
Soft Star Shoes Minimal, basically leather socks. Based in Corvallis
Tune Men’s penny loafers
Vibram FiveFingers and wrap shoes
Vivobarefoot Lightweight, minimal shoes and boots
Xero sandals, including DYI

 

Again, not everything these places sell will be good for your feet. Double check the shopping guide. I recommend wearing your new shoes inside for a while on a trial run (so they are returnable) before venturing out.

Chiropractic, a second look

Many D.C.s are great. If you are seeing a chiropractor and have had good success, fantastic! I am the last person to interfere with something that’s working. But if your “genius” has been “fixing” you for years and you are still the same as when you started… it might be time to rethink chiropractic.

I am NOT a fan of the subset of chiropractors who indiscriminately and overzealously use HVLA adjusting (high-velocity, low amplitude – you know, that violent cracking). Low-force chiropractic like Network, BGI, and activator is absolutely safe, and there are lots of other techniques besides HVLA that are fine. HVLA is appropriate when used to correct an acute injury, like putting a dislocated shoulder back in the socket, but it should not be a frequent therapy. Repetitive stress of supportive ligaments and the resulting inflammation will actually damage the joint.

My information comes from my time at chiropractic school (I completed the first year, including the entire series of cadaver dissection, with nearly straight A’s), my knowledge of functional anatomy as a certified personal trainer and amateur bodybuilder, my 10 year partnership with an Osteopathic medical doctor, my experience seeing patients who have been damaged by repetitive HVLA, and discussions with many physicians of all types. I welcome input from any chiropractor who is interested in a fact-based discussion.

Personally speaking, I suffered a terrible injury when my car was broadsided in the first week of chiropractic school. Their treatments were making me worse, and the more I learned in school, the more I understood why.

1) It doesn’t treat the cause of the problem. Bones don’t move by themselves. If a bone is repetitively out of place, it’s because there’s a tight muscle pulling it that way. Jamming the bones back will cause micro-tears of that tight muscle. It feels good immediately, because you get a nice adrenaline rush along with your temporary fix. An enlightened chiropractic teacher compared HVLA to the shock and rush you get from a shot of vodka. Addicting, but not necessarily good for you. Unfortunately, as soon as the muscle goes back to its usual tight, spasming self, the bone will be pulled back out of alignment. That’s why you need to go back to the chiropractor the next week. Acupuncture and medical massage use the neurological system to retrain those tight muscles, so real healing can begin.

2) Our ligaments and tendons are there for a reason. They provide much-needed joint stability and hold us together. Repetitive HVLA weakens them, and can destroy your joint integrity. We all know that an ankle, having been sprained three times, is pretty much guaranteed to twist again. You do not want that floppiness in your spine. You should not able to crack-crack-crack your back simply by stretching. That’s called hypermobility and it means you can move too much. If you have already been damaged by too much HVLA, you will need to strengthen your back and abdominal muscles to help support those loose ligaments and tendons. Hypermobile backs are more likely to suffer a serious injury if you have an accident (this is what happened to me!).

3) Your reflexes work against HVLA. Quickly yanking on a muscle – even a relaxed one – can cause damage and inflammation. There’s a built in protective reflex that tightens a muscle when it is suddenly lengthened. You can feel this: Fold your friend’s arm at the elbow and put your hand on their bicep. Straighten the arm quickly, and you can feel the bicep twitch under your hand. Now imagine that happening to an already-sore neck muscle being snapped.

4) The pop means nothing. The cracking sound doesn’t necessarily mean you’ve been adjusted properly. It’s called cavitation, and it means that nitrogen gas, naturally occurring in your joint fluids, has been released. A similar thing happens when you open a can of soda. The sound means the bones have been rapidly separated (opening the joint space) and then have come back together. They may have come back to the same position, a better one, or a worse one. Misalignments, when corrected gently OMM style, do not make a cracking noise because the joint space is eased into the correct position rather than violently forced.

5) First, do no harm. Some chiropractors don’t bother to diagnose which level is dysfunctional. They just “shotgun” you by cracking all the vertebrae in your spine. Then they flip you over and do the other side. Why cause stress and create inflammation in a joint that’s working? Added bonus: Whenever you have inflammation, scar tissue forms. Trauma (HVLA) every week leads to more and more scar tissue building up. That’s the last thing you need when you’re already hurting.

6) With repetitive strong adjustments, your body becomes dependent on that input. In chiropractic school we joked about “welfare spines.” I had a discussion with an instructor who was brutally blunt about the temporary nature of his treatments. “Of course they have to come back. That’s how you buy your boat.” I found that model of “medicine” distasteful and unethical. I prefer to help the body heal itself. I love acupuncture and OMM because they truly correct how your muscles function.  Combined with proper exercise*, this creates a body that is strong and capable of bouncing back after a minor injury. I don’t want to see you every week for the rest of your life. I’d prefer to get you better and self-sufficient, and then stay in business by fixing all your friends and family. :)

BTW:  “But I can’t help it!” When you are out of alignment, your body will naturally feel compelled to snap itself back in place. After my injury I used to violently crack my neck and back all the time. It never really solved the problem, though… refer to point 1 above! The good news is that the desire to self-adjust melted away when my muscles – and more importantly, the neurons controlling those muscles – were corrected by acupuncture and Osteopathic medical massage.

*Exercise is essential to strengthen weak muscles, remind tight ones how to relax, and get all your muscle fibers integrated and working together. We are built to move! I know firsthand how pain makes you want to curl up on the couch and wait for it to heal, but the hard truth is that it won’t really repair until you put in the work. Get on an anti-inflammatory diet, see me for basic physical therapy-type exercises, and start walking! Better yet, see an expert personal trainer.

 

Unexplained pain & its various causes

There are many reasons your body can hurt. It’s really frustrating when you don’t understand why, but often unexplained pain just means it doesn’t fit into a nice diagnostic box. We’re all familiar with muscle strain/sprain, fatigue, inflammation, and arthritis… you probably already know that acupuncture can help with these. Less understood by the general public are these causes of pain:

Viscero-somatic referral (Viscero= organ, Somatic=relating to the body): In this case your brain misreads a distress signal, so an organ problem feels like a muscular problem. The most famous example is the heart attack that creates an aching arm or jaw, or bone cancer masquerading as a back strain. Pain that doesn’t respond to treatment needs to be assessed by a medical professional to rule out dangerous causes.

Chronic spasticity: Healthy muscles are constantly changing their level of tension. They work with constant feedback from the cerebellum (part of the brain) to make tiny adjustments. This is how we keep our balance and perform tasks smoothly. When a muscle is tight for a long period of time, however, its setpoint changes. It thinks being tight is normal – this is called spasticity. It leads to stiffness, pain, and misalignment of bones as they are pulled out of place. Blood flow is blocked, creating painful ischemia. Tight muscles and misaligned bones can pinch nerves causing “electric shocks,” tingling, or numbness. This is what I see most often when people come in with unexplained pain. There’s nothing to show up on an X-ray or MRI, because the problem is functional, not structural. Massage is a great temporary relief, but to really fix it you need to treat the cause of the problem, the neurological setpoint. Acupuncture and Osteopathic-type medical massage remind the nerve controlling the muscle how it’s supposed to behave. Once the muscle relaxes, bones return easily to their proper place, and the body can heal itself.

Fascial adhesions: Each muscle fiber has connective tissue, called fascia, surrounding it like a layer of Saran wrap.

Connective tissue (white) and muscle fibers. When fascial adhesions form, it can cause unexplained pain.

Connective tissue (white) and muscle fibers

It may help to picture a muscle fiber as a drinking straw in a paper wrapper (sheath of fascial connective tissue). At each end, that fascia becomes our tendons. These sheaths are supposed to slide past each other as muscles move. With long periods of no movement, if the muscles are spastic, or if there’s an injury, they can stick together and form a fascial adhesion. When your muscles are shrink-wrapped together, it can cause muscle stiffness and unexplained pain. Some people like to get in and dig the adhesions apart, deep-tissue massage style. That works well in the short term, but it also causes inflammation… which causes scar tissue… so the adhesions reform.

Myofascial release can help with unexplained pain.Myofascial release, a type of medical massage, uses a more subtle approach to slide the layers apart. I love doing this type of work because the result is immediate freedom of movement with no pain and no boomerang side-effects.

Emotional causes of pain: Sometimes the pain of an injury lasts far longer than it logically should. This usually points to an emotional attachment. The brain literally links the muscular dysfunction with the memory, and the unresolved post-traumatic stress around the incident will actually prevent the body from completely healing. This can happen with gradual, cumulative injuries too: Imagine a tight neck from a job you hate. Patients will frequently have an emotional release when we start working on the physical site. They may start crying, get angry, or suddenly find themselves terrified “for no reason.” Once we get those remaining feelings flushed out, the muscles and tendons often recover rapidly. If you feel something emotional happening during a session, let it out! Releasing pent-up emotions is therapeutic for your body as well as your soul.

Doctors used to blow off psychosomatic illnesses as “all in your head” and not worth treating. The medical community now has a better understanding of the interplay between the mind and body. It’s a two-way street, and they affect each other profoundly. Chronic pain will screw up your neurotransmitters (chemicals in your brain) and temporarily change your personality. Likewise, an overthinking, worried mind can trigger digestive troubles like IBS (Irritable Bowel Syndrome).

If you have a chronic injury that isn’t healing, it’s worth reflecting for a few minutes. Is there anything your body is trying to tell you? If so, consider talking it out with a therapist or a good friend. Acupuncture can help balance your emotional life, but there may be some work needed on your part, too. Of course you’re welcome to discuss anything in our sessions, and your confidentiality is always assured.

 

 

Piercings and Tattoos

Image

Tattoos and Piercings: Are there unintended effects?

(written August 2011)

I spent last weekend at the Portland Tattoo Expo, giving bodywork treatments to tired tattoo artists and attendees. What a fun experience, to be surrounded by illustrated people!

Body modification is nothing new. I’m sure the first caveman had a good time jazzing up his chassis, starting with paint and continuing on to more permanent decisions. The location, color, and motifs of these designs have been important in many ways. They have indicated status and held religious meaning. They have shown membership in a larger group, or had medicinal or protective properties. Of course in some cultures they are just creative, artistic expressions of the human spirit.

Otzi the Ice Man and his tattoos

“Otzi the Ice Man” lived 5,300 years ago. His frozen body, discovered in 1991, has revealed much about prehistoric life. I could write pages about the secrets he shared, but for now let’s focus on his tattoos. X-rays indicate he had lower back and knee pain.  The dotted and lined tattoos he bore relate to acupuncture points to treat those areas. They were hidden under clothing, so they were clearly not just decorative.

Update 1/8/13: Otzi now “lives” in a museum exhibit in northern Italy.

My first thought was a question. I wondered if the application of the tattoos was itself the treatment, or if it was a guide to show him where to apply acupressure. I’ve certainly been known to send patients home with Sharpie marks to indicate where they should press for the next few days. The process of tattooing will of course stimulate the point, and act as an effective treatment. Long term, however, the ink doesn’t continue to activate the area (as far as I know).

Piercings have a more lasting energetic impact because of the jewelry. Metal blocks energy flow. I think this is actually how acupuncture works – the surgical steel of the needle disrupts the energy flow and draws the body’s attention to the area. A tiny needle, in place for a few minutes, has a therapeutic effect. A large gauge piercing, worn permanently, can cause problems by overstimulating the area. I’ve had patients develop unexplained shoulder pain, digestive trouble, and migraines following body modification to those corresponding points on the ear. I encourage them to either remove the piercings or at least switch to glass or bone. Personally, I wear earrings out for events, but not day-to-day and I never sleep in them. I used to have a belly ring but had to remove it due to interference with my Ren channel. Not everyone is sensitive, though: Plenty of people have piercings with no ill effects. It’s up to you as an individual to weigh the impact vs. advantage.

There was a recent discussion on an acupuncturist’s discussion board where a number of providers cited patients unconsciously placing tattoos where they need treatment. For example, someone with a Spleen* deficiency having a design above her inner ankle. I haven’t seen that trend myself, but I do recall a particularly disturbed young man I met while waiting in line for a fitting room at Goodwill. He was clearly mentally ill, and very agitated. He had Shenmen (the seat of mental health) pierced on both sides, an unusual location for an earring. I asked him why he chose that site, and he said it just felt right.

Where are your piercings?

Ear acupuncture points (most of them) with Shenmen marked.

I’m not anti-body-modification. In fact, I have a ankle bracelet tattoo myself that says “VIVO VT SERVIAM” – Latin for “I live to serve.” As with all big changes to your body, however, you should undertake them with thought.

*Remember that in Chinese medicine, capitalized organs are energetic concepts and should not be confused with your anatomical organs. In this case, the Spleen transforms food into energy, while your physical spleen stores and filters blood, and plays a role in the immune system.

 

Fibromyalgia & how to beat it

The FIRST thing to know about Fibromyalgia is that it’s real.

The SECOND thing to know about Fibromyalgia is that it doesn’t have to be forever.

So many people, when they are finally diagnosed, have a bittersweet reaction. At last, they know what is wrong. They might feel vindicated, having endured the eye-rolls and boredom of family members who didn’t believe anything was really wrong. On the other hand, some patients take the diagnosis as a death sentence. They’ve heard nothing but a negative prognosis. They think they are stuck with the pain for the rest of their lives. Some people, exhausted and depressed, can even take on the disease as an identity. DO NOT do this. You are a beautiful person dealing with a temporary disease. There’s a Southern saying “If you’re going through Hell, don’t pitch a tent!” This is perfect advice. Resist the urge to wallow. Focus on the things you CAN do to make yourself better, and keep moving!

I am here to tell you that you CAN overcome Fibromyalgia. I used to have it myself. Now, as long as I am reasonable with my diet and exercise, I am symptom-free!

I see FM as a kind of physical Post-Traumatic Stress. Generally it can be traced back to a physical or emotional trauma. The body’s pain system becomes oversensitive. It reads any little insult as a major injury. To stop this over-reaction, we have to decrease inflammation, reduce stagnation, and decrease stress.

Sleep: See my article on Sleep. Letting your body restore itself overnight is very important!

Exercise: Light, frequent exercise is key to reducing pain. In severe cases, you may need to start with a 5-10 minute walk once a day. That’s fine… just gradually increase the duration. Get up and move a little every few hours instead of sitting still all day. Try to keep your activity levels about the same day to day. Doing too much or being too sedentary will hurt – listen to your body!

Nutrition: Making a few changes in your diet can drastically reduce your pain. Avoid the inflammatory nightshades (tomatoes, potatoes, eggplant, peppers, tobacco) as people with FM tend to be sensitive to their natural alkaloids. Sugar is the other big offender. Some people are more sensitive to dairy products, commercial red meat, alcohol, and caffeine than others. It’s worth experimenting a little to find out how your body reacts. Go two weeks without the item in question, then have a big dose. See how you feel that day and especially the next. The answer is usually pretty obvious. If you’re ready/able to make big changes in your diet, you may find that eliminating starches (pasta, bread, rice, etc) can be surprisingly helpful.

Try to eliminate fried and processed foods from your diet as much as possible. Anti-inflammatory foods like dark leafy greens and good fats are important to include.

Relaxation: Being happy is important, too. Pamper yourself by allowing time to read or pursue your other hobbies. Have fun! Enjoy a funny movie, hang out with your friends, pet a cat. Pay attention to the beautiful things in your everyday life.

Good touch: The hypersensitivity of fibromyalgia means that the wrong kind of pressure, even well-intentioned, can be very painful. Deep-tissue work and hard hugs are not appropriate. Instead, I use a gentle touch. Careful medical massage, using a large contact (palm of the hand) instead of a pokey one (fingertips), is wonderful for helping disperse blood and lymphatic stagnation. If there’s a partner in your life, I can teach him or her how to work on you. I am also conservative in my needling for FM patients. I use the skinniest possible (42 gauge) and not many of them… too many can wipe out your energy.

Address the cause: Most FM seems to stem from a past trauma, either physical or emotional. Many patients report a history of abuse. Find a good therapist or some other way to address any hidden grief. Some patients find it useful to write letters to people involved in these emotional injuries. Say it all. You can even write one to yourself (current you or younger you). It doesn’t matter if the person is still part of your life or if they are still alive – it’s about expressing yourself. Afterwards, burn the letter as a symbol of letting go of those emotions.

I can’t overstate the importance of this step. You may feel like you’ve dealt with whatever trauma kicked your FM off, but stop and think. Those land mines can be buried deep. In my case, I had to dig back to my sister’s death when I was 18, as well as the obvious car accident. Once I re-addressed my grief, the majority of my symptoms melted away. Take some time to find the splinters in your soul.

Keeping your identity as separate from a disease, and focusing on the actions you can take, is important for everything herpes to HIV. Some people with long-term managed illnesses, like diabetes or fibromyalgia, actually wind up healthier because they get serious about their diet and exercise. This life is what we make of it. Go make something awesome! 

 

Common Typical TCM (Traditional Chinese Medicine) Patterns for Fibromyalgia

One person may exhibit more than one pattern.

Liver* Qi Stagnation – anxiety, emotional upset, headaches (including migraine headache), being easily angered, muscle stiffness in neck and shoulders, insomnia, waking frequently and having difficulty falling back to sleep, irritable bowel syndrome. All symptoms may be triggered by emotional stress.

Qi and Blood Deficiency – specifically spleen Qi deficiency and heart blood/liver blood deficiency, with such symptoms as chronic fatigue, exhaustion, dull headache, muscle weakness and numbness, insomnia, dream-disturbed sleep and waking up tired, palpitations and depression.

Qi Stagnation and Blood Stasis – aches and pains in the whole body, burning or gnawing pain with tingling sensations in extremities, headaches.

Kidney* Deficiency (either Yin, Yang, Qi or Essence Deficiency) – there will be impotence or lack of libido for males and infertility issues for both males and females. Other symptoms: sore lower back with restless leg syndrome, irritable bladder, dysmenorrhea, amenorrhea, premenstrual syndrome, hot flashes and night sweats.

* Please note that the Chinese organs are energetic concepts and may or may not relate to the physical organs!

Acupuncture and Chinese medicine provide relief of symptoms by balancing Yin and Yang, and adjusting the circulation of Qi and the blood. Local measures such as heat, gentle therapeutic massage, and moxibustion* in specific regions also help to reduce the pain. A regular plan, with long-term, consistent integrative treatment is necessary in patients with fibromyalgia.

* I prefer myofacial release and moxa as methods to break up stagnation rather than cupping for people with fibromyalgia. Cupping, especially if done too harshly, creates bruising / bleeding under the skin and contributes to excess inflammation.

Acupuncture and Post-Stroke Spasticity (contains Chinese medicine theory)

EDIT 1/22/15: Since I posted this I’ve gotten a lot of emails from people all over the world wanting to know if I can help them. Unfortunately, I don’t know anyone I can refer you to outside the US… outside the American Pacific Northwest I do not have much connection with other acupuncturists.  

Also, it’s impossible for me to know how many sessions your recovery would take. There are so many factors – your condition, your general vitality, your diet, how much physical therapy you do, etc. 

To find a local acupuncturist, first ask around and read a lot of reviews (Yelp, Google, even ask your neuro docs if they know of someone local). There’s a big variation in skill / talent among practitioners, and there are lots of different styles. Feel free to try a few and fire anyone who doesn’t mesh with you. Be aware that with neurological repair it may take weeks to get observable results, which can complicate your decision. Be patient.

If you can find someone locally who does medical massage (advanced techniques are much better for this than regular relaxing massage or “deep tissue”), that will be helpful. Usually the muscles and nervous system need to be re-trained so they aren’t so spastic.
I recommend self-stimulation (rub with fingertips) all over the ears and scalp, especially Du-20 and the scalp from the ears forward. Also, stimulate points LI-4, LV-3, and GB34, and BL 62 (just under the outside ankle bone). You can do that up to a few times a day. 
Use regular (2-3 times a day) exercises to try move your body – even if you can’t see it move – imagine it and try. Visualize doing a movement you know well, like a sport, playing a musical instrument, or typing. Moving – especially novel movements – will help your neural repair more than anything else. It’s ok if you are shaky or inaccurate in your motor control, you just have to keep trying things. 
Avoid processed food. Eat lots of veggies. Good quality protein (grass-fed / pastured animals) and fats (avocado, nuts, seeds) are important to support your nervous system. 
Most important – try to keep a positive outlook. I know it’s very difficult in a frustrating situation, but focusing on the good parts of your life will keep your body less stressed, and it will heal better (When you are in “fight or flight” mode your body won’t expend energy on healing / digesting as much). Meditation, breathing exercises, etc can be helpful. 

If you are doing this research on behalf of a loved one, I would also recommend you look into a caretaker support group for YOU. It can be a huge stressor. In addition to practical advice, you can really benefit from talking to someone who understands your situation.

I hope this helps you in your recovery. If I can be of further help please let me know!
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EDIT 7/1/13: A note on longer-term neurological repair: The current “common knowledge” in the Western medical world is that most nerve repair will happen within 6 months of the injury. After that, they say, you are stuck with whatever impairments you still have. I want people to know that while it’s harder to achieve progress past the 6 month mark, it’s by no means impossible! I had a patient who suffered a stroke 17 months before I saw her. When we met, she was locked into position in bed, bent, twisted and looking into the corner of the ceiling. She was unable to move her limbs or speak. When I arrived for her fourth visit in as many weeks, she was sitting up and cracking jokes. Her legs had straightened out, and she had regained enough control of her hands to eagerly anticipate knitting again! While these results are not average, they provide hope, as does this article.

NOTE: This is a transcript of a presentation geared to healthcare providers who have no experience with Chinese medicine (doctor’s office staff, etc), and focuses on recovery rather than prevention. It was written as part of my thesis project for my Master’s Degree at the Oregon College of Oriental Medicine in 2005. It was  updated with the newest demographic information in 2011 but otherwise left in its original form.

I’ve always had a personal love of the science of the human body. I was a bodybuilder and personal trainer focusing on rehabilitation and core strength for three years. Working with my clients was thrilling but I knew I needed more education. I took the full battery of medical prerequisites and went to chiropractic school. After the first year I knew their method of adjusting wasn’t a good fit for me, but I’m grateful for what I learned in the cadaver lab and in lecture classes. I took that base of knowledge to the Oregon College of Oriental Medicine where I earned a Master’s degree in Acupuncture.

According to the American Stroke Association, nearly 800,000 people each year suffer a stroke in this country (this number was 700,000 in 2004). On average, an American suffers a fatal stroke every 3-4 minutes. It’s the third-largest cause of death behind heart disease and cancer. Strokes are not always fatal, of course. They are a major cause of disability, and are responsible for an estimated 550,000 disability cases per year. For many survivors, the ordeal may be just beginning.

More than 75% of stroke patients have motor impairments, often resulting in disability, such as impaired ambulation and inability to perform activities of daily living (ADLs) (Wojner). ADLs are the basic tasks of everyday life such as eating, bathing, dressing, toileting, and transferring (Wiener). Suddenly being handicapped can cause embarrassment, frustration, and profound depression for the post-stroke patient. Caretakers and family members also experience stress, both psychological and financial. Americans will pay about $68.9 billion in 2009 (this number was $57 billion in 2005) for stroke-related medical costs and disability (American Stroke Association).

CVAs – Cerebral Vascular Accidents – come in two flavors, ischemic and hemorrhagic. The ischemic (lack of blood) type is much more common (82%) and results from a clot stopping blood flow to part of the brain. It could be a local cerebral thrombus, or an embolism from a distant clot that occluded a cerebral artery. The hemorrhagic type, as its name suggests, results from bleeding from an intracerebral artery. In either case, the patient can suffer long-term ill effects ranging from poor memory or speech problems to paralysis.

TIAs – Transient Ischemic Attacks – are mild or “mini-strokes.” They produce brief periods of damage that resolve without medical intervention, sometimes within minutes.

Unfortunately, with most CVAs there are lasting repercussions. Symptoms will vary with the location of the brain damage. If Broca’s Area is deprived of oxygen, for example, the patient will have difficulty with speech production. If the posterior brain is affected, the patient will have impaired vision. Today I will focus on treating damage of the motor area of the brain.

After recovery from a stroke, a patient can frequently have motor weakness on one or both sides of the body. Further impairing mobility and function in this patient population is spastic hypertonia. This abnormally excessive muscle tone can cause many problems, including pain, loss of free movement of a limb, and interference with the ability to walk and perform daily activities, such as bathing or dressing. It also may cause the limb to become “fixed” or frozen in an uncomfortable position (Meythaler).
There are two nerve cells that control each muscular contraction, the upper and lower motor neurons (UMN and LMN). The upper motor neuron begins in the brain and descends through the spinal cord. It synapses (meets) with the lower neuron, which goes to a muscle. The LMN creates contraction, so damage below the synapse will result in flaccid paralysis. This is the typical post-trauma paraplegic with atrophied legs. By contrast, the upper motor neuron normally inhibits contraction. When the UMN is damaged in a stroke, the muscles are never turned off: patients have perpetually spastic muscle tone. They might have their arms pulled up tight against their bodies, or legs that want to stay crossed. In cases that affect fine motor control, writing and other small tasks are compromised. You may see a similar pattern in people who have suffered head trauma. Post-stroke spasticity creates uncontrollable muscle tightness that can cause painful muscle cramps, particularly in the arm and leg.

The current allopathic toolbag for hypertonicity is quite large and still evolving. Systemic antispasticity drugs have fallen out of favor, because they are nonselective in action and may cause functional loss of normal muscles. Some doctors like to use muscle relaxants, like tolperisone – a centrally acting muscle relaxant with membrane stabilizing activity. Stamenova conducted studies that showed tolperisone to be safe and effective in reducing spasticity as measured by the Ashworth scale.

The most common type of treatment is a local blocking agent: a medication that will deliberately impair the transmission between lower motor nerves and muscles. When the nervous system sends these abnormal commands to contract, the messages are no longer transmitted to the muscle and the muscle remains relaxed (Bakheit). Botulinum toxin has been widely used with good effects and can be performed as an outpatient procedure without anesthesia.

The pharmaceutical management of spastic hypertonia following stroke has generally been confined to the use of approaches that reduce activity at the neuromuscular junction (botulinum toxin), inhibit the release of calcium from the sarcoplasmic reticulum (dantrolene sodium), or those that act centrally (baclofen, diazepam, and clonidine). Ablative procedures are performed, such as phenol injections to the motor points or nerve blocks by injection. These procedures generally require repetition and have been associated with permanent weakness, and loss of muscular control (Meythaler).

Most recently, intrathecally delivered baclofen has been established as a treatment method in acquired brain injury. A catheter is inserted into the spinal canal and a radio-transmitting device delivers medication directly into the fluids surrounding the spinal cord. Baclofen binds to presynaptic GABA-B receptors within the brain stem and other central nervous system (CNS) sites. By blocking the transmission of neural messages, it prevents muscular contraction.

Physical therapy is another commonly prescribed modality for stroke survivors. This can range from gait retraining with a parachute harness over a treadmill, to personal training with free weights or elastic bands. Occupational therapists can intervene with training of sensory-motor functions, training of cognitive functions, training of skills such as dressing, cooking a meal, or performing domestic activities, advice and instruction in the use of assistive devices, provision of splints and slings, and education of family and primary caregivers (Steultjens). Previously, doctors feared that physical exercise would exacerbate spasticity. Research has shown instead that exercise such as pedaling a bike is a beneficial intervention for achieving gains in muscular force output without worsening motor control (Brown).

Now that we have an overview of the main techniques used to treat spasticity, let’s compare their outcomes and side effects:

There are a number of studies on botox injections as an antispasmodic, with both upper and lower limbs. Success rates in reducing spasticity are impressive, but are accompanied by muscle weakness. For example, Berlin’s Dr. Hesse noted weakness in the anterior tibialis (shin muscle, which lifts the foot) after injections of the gastrocnemius calf muscle. Side effects are known to include bleeding, skin rashes, or tenderness at the injection site, as well as flu-like symptoms (Bakheit, et al). The main drawback to botox injections is the short-lived benefit: Three months of relief seems to be average (Bakheit, et al).

Unlike other drugs used to treat spasticity, tizanidine has not been shown to cause muscular weakness (Wallace). However, it has other significant drawbacks. The side effects seen with tizanidine in this study were similar to those previously reported. In both Wallace’s and Gelber’s work, the most common were sedation, dizziness, dry mouth, and hypotension. Nearly 15% of their patients withdrew from the study because of these side effects. All of these patients developed these side effects at very low doses of tizanidine.

Intrathecal Baclofen delivered by a pump can vary the amount of medication during the course of a day. It’s effective for the lower limbs and torso, but has less predictable effects for upper limbs. Intrathecal delivery causes less sedation, lethargy, and weakness than oral Baclofen, with a stronger nerve action. It requires that a surgeon or an anesthesiologist implant a small tube into the spinal cord and a pump under the abdomen skin, and is best used for patients that have severe spasticity, particularly those with a spinal cord injury or multiple sclerosis (Ivanhoe).

Although all of these types of therapies have provided relief for patients, there is still a need for alternative therapy. Acupuncture is an appropriate adjunctive therapy for those patients who want to avoid additional drugs. Many of the patients who suffer strokes tend to be taking multiple medications. Providing relief without inducing additional drug interactions is a beautiful bonus.

Acupuncture also provides a more holistic answer when compared to botox injections. Why deaden an operating nerve (the lower motor neuron) when the damaged UMN is the problem? Two wrongs do not make a right – they create further insult to the body. TCM (Traditional Chinese Medicine) focuses on healing the original injury. Needles have been used with good success in treating neurological problems and can help stimulate nerve regrowth and recovery.

There are many styles of acupuncture, including Japanese, 5 Elements, Classical, etc. but this lecture will limit itself to TCM acupuncture. Its roots are ancient: some sources indicate needles were used for healing as much as 4000 years ago. Acupuncture in its present form was practiced 2000 years ago. Much of the theory is based on empirical science – that is, trial and error! Over 40 centuries they figured out some pretty amazing things about the human body. Before I can explain them, though, it’ll be helpful to understand the framework of TCM theory.

Acupuncture deals primarily with Qi, usually translated as Energy. There are many types of Qi. Some represent functions as well as energy. For example, our Defensive Qi, (Zheng Qi) does battle with pathogens (Xie Qi). Our Prenatal Qi (affected by genetics and the prenatal environment) is sort of our potential vitality (Jing). Children with birth defects are said to be deficient in Prenatal Qi. Postnatal Qi is affected by diet and life experiences, and we can use it to supplement and fortify our vitality. Too much stress or a poor lifestyle will drain our Jing and lead to premature aging.

The most basic differentiation in Chinese Medicine is that of Yin and Yang. Yin is the darker, moister, interior, still, nourishing, more feminine half. Yang is light, dry, exterior, expanding, moving, and more masculine. As applied to anatomy, the front and lower parts of the body are Yin. The back and upper body are considered more Yang. On the lower limbs, medial is Yin (think interior) and the lateral aspects are Yang. This will be important later when we devise a treatment strategy.

Yin & Yang aspects of the body

Our Qi flows in a series of meridians, or channels. These are rivers of energy flow that travel along specific paths, and were mapped out 2000 years ago. Chinese anatomical position describes the arms as lifted straight up, so the body forms a symmetrical X. The Yang channels start high and travel downward: from fingertips to the head, and head to the toes. The Yin channels start below and rise, to carry nourishing energy upwards: they run from the toes up, and from the torso to the fingertips.

At some areas of the body, the Qi bubbles closer to the surface. In these places we can access the energy more easily. These are acupuncture points. Acupressure, simply pressing with a fingertip, is also effective at these spots. There are 365 points on the channels. Including auricular sites and extrachannel points, there are about 1000 altogether.

The 12 ordinary meridians are each linked with an energetic organ. These are the Heart, Pericardium, San Jiao, Small Intestine, Large Intestine, Lung, Kidney, Bladder, Liver, Gallbladder, Spleen, and Stomach. The organs are bundled into Yin/Yang pairs. The eight extraordinary meridians are not linked to organs. Instead, they treat on a more constitutional level. We’ll see later how these eight can be particularly useful in treating post-stroke spasticity.

The Chinese have ascribed energetic properties to the various organs. Each organ is tied to one of the five elements: Wood, Fire, Earth, Metal, and Water. The elements are associated in a complex series of cycles, so each can influence the others. The organs (and elements) are also linked to a sense, flavor, color, season, and emotion in addition to their physiological function. Some of these make obvious sense in terms of medical science, like the Heart being the master of Blood.

Other organs may seem stranger at first glance. The Liver, for example, is in charge of emotions and smooth Qi flow. Constant circulation of energy through the meridians is considered essential for health. When Liver dysfunction prevents proper energy flow, the condition is called Liver Qi Stagnation. Anger or irritation is a common side effect. This organ is linked with female reproductive health. If you think about a woman suffering from PMS, you can see that her Liver Qi isn’t moving effectively. Stagnation causes cramps, and her mood swings are legendary. This syncs with modern science if you think about the biological liver’s role in metabolizing estrogen and other hormones.

The liver’s partner is the Gallbladder. Interestingly, it is associated with decision-making and fear vs. boldness. Herein may lie the root of the phrase “Why, the GALL of that man!”

The San Jiao is analogous to the lymphatic system. It controls water and fluids throughout the body, and is important to immune function. It’s paired with the Pericardium, which protects the Heart, and controls chest and abdomen issues.

The Spleen is responsible for transforming energy from food into energy for the body, so it takes on the functions of the biological pancreas and small intestine. If the Spleen is not functioning well, it will produce Phlegm. This can be visible Phlegm – nasal discharge or coughing with sputum – or Invisible Phlegm, which manifests as mental illness or interference with cognitive processes. The Spleen’s partner is the Stomach, which is not substantially different from modern understanding of the stomach.

The Lung captures Qi from the air and is responsible for the skin system and border immunity. Its pair is the Large Intestine, which is most often used to clear heat from infection, to treat the face (where the channel ends), and to aid Qi movement in the upper body.

The Kidneys are considered the storehouse of our vitality (Jing). Our Kidney Qi declines as we age. Women in menopause are showing signs of Kidney Yin deficiency (hot flashes, vaginal dryness, etc.) while men exhibit Kidney Yang deficiency (impotence and urinary difficulties). The Bladder channel runs down the back and contains a series of points called the Shu points that address each of the organs.

Now that we have a simplified understanding of the Chinese organs, let’s examine how their dysfunction contributes to pathology. All CVAs are considered Wind-Strokes. There are four main differentiations for stroke: Liver Wind, Phlegm Fire, Blood Stasis, and Wind in the Channels.

The Liver is the Wood element. Inadequate rest, excess sexual activity, or emotional stress beleaguers Liver’s cooling Yin. When this happens, it cannot balance the Liver Yang. Now the Wood is “on fire”. Liver Yang energy will rise to the head and cause Wind, much like heat from a campfire causes an updraft. Many Chinese medical concepts are taken from observation of nature and the elements.

If a patient has worked too hard or maintained an irregular diet, the Spleen will suffer. Phlegm-Fire will congeal to cloud the brain, prevent speech, and numb the limbs.

If the Kidneys are overstressed, due to lack of rest or excessive sexual activity, they cannot nourish Marrow, which in turn cannot produce Blood. Much like a dried up river, a body with deficiency of Blood becomes a body with Blood stasis. This leads to stiffness and pain in the limbs.

A more generalized understanding of physical overwork and inadequate rest indicates weakness of all the channels. A lack of defenses means that external Wind (including environmental and microbial challenges) will penetrate and develop into internal Wind. Paralysis is a common result.

Strokes that affect consciousness or even create coma are considered to have attacked the organs (viscera) and channels, and are categorized as severe. A CVA that infiltrates only the channels (a mild Wind-stroke) will result only in unilateral paralysis, numbness, and slurred speech.

The appearance of the patient’s tongue is a valuable tool in TCM diagnostics. A purplish tongue, or distended veins on the inferior surface of the tongue, indicate blood stasis. A red tongue body indicates Fire. A stiff, deviated, or quivering tongue reveals Wind, while a sticky coating shows Phlegm. Weakness in any of the organs will show up in specific areas (Kidney at the root, Heart at the tip, etc.).

During the acute phase of the stroke, Western medical care is essential. Time lost is brain lost. TCM can’t compete with MRIs and thrombolytics, and we don’t want to! Once the patient is in a recovery phase, however, acupuncture gives excellent results in the treatment of hemiplegia and facial paralysis. Speed is key here, too. Treatment within one month is recommended. After six months, improvement will generally be slower and less substantial.

Treatment with acupuncture involves choosing points by two methods. We select points with an empirical history of treating Wind-Stroke. These include points known for Wind in general, points to aid muscular control, and points to clear stagnation and stasis. Our therapy plan should also address the channels affected by spasticity.

The eight Extraordinary channels are often used to treat deep constitutional problems. For example, Bl-62 (Master point of the Yang Qiao / Yang Moving Channel) treats muscular dysfunction impairing locomotion. This point is just inferior to the lateral malleolus. The Xi-cleft point of this same channel, ascribed with the ability to remove stagnation, is BL 59, on the lower lateral leg.

Let’s take an example of a male patient with his right forearm fixed in flexion. His arm is pressed against his side, and his hand is curled up against his chest. According to TCM diagnostics, he is afflicted with Wind in the channels. In this case, the channels affected are the Heart, Pericardium, and Lung. Each channel has a point called the Xi-cleft, which is used to dispel accumulated stagnation of Qi and Blood. These would be Lu-6, Pc-4, and Ht-6. These three points are all located on the anterior forearm. We can treat the Xi-cleft points on the affected arm, or on the opposite arm if the points are difficult to access. Wind points such as GB-20 (at the occiput), GV –20 (top of the head), GV-14 (spine, below C-7) would typically be used. LI-4 on the hand will move Qi and Blood through the upper body. St-40 on the lateral leg will disperse Phlegm.

Even within TCM, there are some differing methods of differentiation. Dr. Wu’s textbook separates “Yin Tension” from “Yang Tension” stroke, based on signs of heat or cold in the tongue and pulse. Let’s assume that our patient presents with a red tongue, slimy yellow tongue coat, and a rapid pulse. We would add LU-11, Ht-9, and PC-9. These are the points at the fingertips (extreme ends) of the affected channels.

Wong found that patients receiving electro-acupuncture left the hospital more quickly, with a significant difference in self-care and locomotion. Pei likewise found more improvement in general ADLs with acupuncture. The Swedish studies by Kjendahl found that acupuncture delivered greater improvement on a one-year follow-up.

The Gosman, Hedstrom and Johanssen studies published in Stroke found no significant differences in acupuncture vs. physical therapy in improving post- stroke ADLs, but they neglected to differentially diagnose the patients. Each received the same set of acupoints. This is a huge oversight: Specificity of treatment is essential for an effective result. Grouping everyone together is comparable to treating everyone with a runny nose with antibiotics, then concluding that medications are useless against rhinitis. Instead, we separate out the allergic, the virus-stricken, and the bacterially-infected. Chinese medicine deserves the same rigor of analysis. It’s also worth pointing out that the needles were inserted by physical therapists, not by acupuncturists. The quality of their point location and technique must be called into question.

In conclusion, post-stroke spasticity is a debilitating and frustrating hurdle for many CVA survivors. Modern Western medicine can stop nerve transmission, mute muscles, and retrain patients to help them gain control. Acupuncture can help the damaged nerves to heal, and return to normal function. If doctors and physical therapists work with acupuncturists, we can help our patients achieve a more complete recovery in a shorter period of time. Needles won’t interact with medications, so they are a great adjunct for our more elderly stroke survivors. I encourage you to reach out to Chinese practitioners and build partnerships. Ask questions. Take a look at the research I’ve quoted in my references. Refer some people, and see what happens. I look forward to working with you all!

Assessment of clinical trials

A) C. Werner, et al., Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in sub-acute stroke patients. Stroke, 2002; 33:2895.
1) Training: The people working with the patients were described as “physical therapists” but no additional information was given with regard to their education or experience.
2) Inclusion criteria: Non-ambulatory hemiparetic patients, 4 to 12 weeks after a first-time stroke, age less than 75, requiring firm continuous or intermittent support from at least 1 person to walk, must be able to sit unsupported at the edge of a bed and to stand for 10 seconds without assistance. Hip or knee extension deficit of less than 20 degrees, passive dorsiflexion of the ankle to a neutral position.
Exclusion criteria: Cardiac ischemia, arrhythmia, or decompensation. Resting systolic BP of 200 or more. Maximum heart rate exceeding 190 bpm minus the age of the patient. Severe impairment of cognition or communication.
3) The study was reported as randomized. Sealed envelopes were drawn to assign groups.
4) Demographics and clinical information at onset of the trial is provided and is successfully random.
5) Previous studies on post-stroke treadmill physical therapy were cited.
6) The speed and duration of the treadmill use was given in ranges only. “Physical
assistance […] was administered according to individual needs.” More detail
would be helpful in duplicating this experiment.
7) Assessment made use of the Functional Ambulatory Category (FAC), the RMA
score (gross functions and leg and trunk section), and the modified Ashworth score
testing for ankle dorsiflexion, and mean gait velocity.
8) Outcome measures were assessed by independent raters who were not involved in the therapy, and who were blind to the patient’s grouping. Interrater reliability
scores were provided.
9) Patients were aware of their grouping.
10) Six-month follow-up phone calls were placed and data was gathered on the
persistence of improvement.

B) Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life A Controlled, Prospective, and Randomized Study of Acute Stroke Patients, Gosman,- Hedstrom, et al. Stroke. 1998; 29:2100-2108
1) Acupuncture was performed by 4 physiotherapists (PTs), trained together to give the same information and to use the same techniques. They were not described as having any previous acupuncture experience.
2) Inclusion criteria: Patients 40 years with an acute focal ischemic nonhemorrhagic lesion were invited to take part in the study. The stroke onset had to be less than 1 week before the randomization. Exclusion criteria: These criteria included other severe disease necessitating hospital or nursing home care; severe aphasia or unconsciousness; an earlier cerebral lesion, with a documented need of care; and treatment with a cardiac pacemaker.
3) The study was reported as randomized. Computers were used to assign groups. 4) Demographics and clinical information at onset of the trial is provided and is
successfully random.
5) No explanation was given for the points chosen.
6) The locations, stimulation, and retention of acupuncture needles were all described.
7) Assessment made use of the Barthel Index and Sunnaas Index of ADL. The NHP questionnaire, a self-instructive instrument, was given to the patient and collected on the assessment occasion by the occupational therapist.
8) Two occupational therapists (OTs), who were blinded to patient allocation after
randomization, evaluated the treatment effects on ADL, health-related quality of
life, and use of health care and social services.
9) Patients were aware of whether they received acupuncture or not. No information is available regarding the patients’ knowledge of multiple groups.
10) The assessments were performed 4 times during the first year: 3 days after
randomization and at 3 weeks, 3 months, and 12 months. The assessments were done by means of interviews and observations at the hospitals, nursing homes, and/or in the patients’ homes.

C) Acupuncture and Transcutaneous Nerve Stimulation in Stroke Rehabilitation, Barbro B. Johansson, MD, Stroke. 2001; 32: 707-713.
1) Training: “[T]he therapists received training that ensured uniformity in the treatment procedures between centers. Each therapist performed all 3 treatment modalities.” Obviously the therapists were not trained acupuncturists.
2) Inclusion criteria: Patients of all ages and both sexes were eligible if they had had an acute stroke between 5 and 10 days before randomization. Only patients with moderate or severe functional impairment at randomization were included. This was defined as a Barthel ADL Index 21 of 70 points in combination with inability to perform the Nine Hole Peg test 22 within 60 seconds (impaired fine motor function of the hand) or inability to walk 10 meters without mechanical or personal support.
Exclusion criteria: If the stroke was a recurrent one, the patient could not have been functionally impaired before the present event. Exclusion criteria were (a) previous neurological, psychiatric, or other disorder making it difficult to pursue the treatment or evaluations, (b) inability to comprehend information about the trial, (c) concurrent participation in another trial of interventions supposed to affect long-term neurological and functional outcome, and (d) failure to obtain informed consent.
3) With the use of closed envelopes and stratified by center, eligible patients were randomized in blocks.
4) At baseline, patients in each group were closely similar in all important prognostic variables. Table provided.
5) No explanation for the points chosen were given.
6) Needling technique was adequately described.
7) ADL function was assessed by the Barthel Index, 21 overall motor function by the Rivermead Mobility Index, 23 fine motor function by the Nine Hole Peg Test, 22 walking ability by the time needed to walk 10 meters (with or without mechanical support), and quality of life by the Nottingham Health Profile.
8) An independent observer unaware of the group to which the patient had been assigned performed all investigations and recordings except monitoring of adverse reactions during treatment. Patients and observers were instructed not to discuss the treatment sessions.
9) Patients were aware of whether they received acupuncture or not. No mention was made of the level of awareness re: multiple groups.
10) Follow-ups were conducted at 3 and 12 months.

References: 1) http://www.strokeassociation.org : The web site of the American Stroke Association.
2) Bakheit, A. MD, et al. A Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study to Compare the Efficacy and Safety of Three Doses of Botulinum Toxin Type A (Dysport) With Placebo in Upper Limb Spasticity After Stroke, Stroke. 2000;31:2402-2406.
3) Brashear, Allison M.D. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med 2002 Aug 8;347(6):395-400
4) Brown, D.A. PhD, PT; S.A. Kautz, PhD. Increased Workload Enhances Force Output During Pedaling Exercise in Persons With Poststroke Hemiplegia. Stroke. 1998;29:598-606
5) Gelber, David A. MD et al, Open-Label Dose-Titration Safety and Efficacy Study of Tizanidine Hydrochloride in the Treatment of Spasticity Associated With Chronic Stroke. Stroke. 2001; 32: 1841-1846.
6) Gosman,-Hedstrom, et al. Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life A Controlled, Prospective, and Randomized Study of Acute Stroke PatientsStroke. 1998; 29:2100-2108
7) Hesse, S. et al. Ankle Muscle Activity Before and After Botulinum Toxin Therapy for Lower Limb Extensor Spasticity in Chronic Hemiparetic Patients S. From the Klinik Berlin, Department of Neurological Rehabilitation, Free University Berlin (Germany) (S.H., D.L., M.T.J., K.H.M.), and the Rehabilitation Institute, Ljubljana, Slovenia (J.K., M.G.). Correspondence to Stefan Hesse, MD, Klinik Berlin, Kladower Damm 223, 14089 Berlin, Germany.
8) Hesse S, et al. Botulinum toxin treatment for lower limb extensor spasticity in chronic hemiparetic patients. J Neurol Neurosurg Psychiatry. 1994;57:1321- 1324.
9) Hu HH. A randomized controlled trial on the treatment for acute partial ischemic stroke with acupuncture., Neuroepidemiology. 1993; 12(2): 106-13.
10) Ivanhoe, MD, by Cindy B. Alberto Esquenazi, MD, and Nathaniel H. Mayer, MD. http://medbroadcast.healthology.com articles
11)Johansson, Barbro B. MD, Acupuncture and Transcutaneous Nerve Stimulation in Stroke Rehabilitation, Stroke. 2001; 32: 707-713.
12)Johansson, K RN, Sensory stimulation promotes normalization of postural control after stroke. Stroke 1994 Jun; 25(6): 1176-80.
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14)McGuire JR, Harvey RL. The prevention and management of complications after stroke. Phys Med Rehabil Clin North Am. 1999;10:857– 874.
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17)Meythaler, Jay M. Intrathecal Baclofen for Spastic Hypertonia From Stroke, Stroke. 2001;32:2099-2109
18)Nan, Fatma. Pathophysiology And Rehabilitation Of Upper And Lower Motor Neuron Syndromes, Hacettepe University.
19)Ogawa N, Asanuma M, Hirata H, Ota Z, Yamawaki Y, Yamamoto M. Development of a simple spasticity quantification method: effects of tizanidine on spasticity in patients with sequelae of cerebrovascular disease. J Int Med
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Copyright 2011. Rose City Acupuncture.

Anti-inflammatory Diet & Nightshades

If you have osteo-arthritis or an inflammatory disease (Fibromyalgia, IBS, etc), listen up: There are ways to alter your diet that will help decrease your pain! It’s also very helpful when you want to reduce inflammation after an injury.

1) Avoid sugar. This includes soda* and high-glycemic foods that will break down quickly into sugars. White bread, pasta, and starches will all contribute to inflammation.
2) Avoid fried foods. Enough said.
3) Grain-fed red meat is a problem for some people. Grass-fed meat is less inflammatory, since the fat structure is different.
4) You can counteract pain by eating ANTI-inflammatory foods. Dark leafy greens like kale and spinach will help a lot. Berries (except for goji and blueberries), turmeric, garlic, celery, pineapple, cocoa, ginger, and foods containing good fats (extra-virgin olive oil, avocado, salmon, nuts) are great, too. If you are sensitive to oxalates, however, be careful not to overdose on the dark leafy greens.

5) Foods your body doesn’t like. Some people are sensitive to dairy or wheat, for example. If you know you react badly to something, avoid it when you are in pain.

6) The Nightshade (Solanaceae) plants contain a small amount of an alkaloid toxin called solanine. Some people aren’t bothered by it. Other people, especially those with auto-immune issues & arthritis, tend to be sensitive to this family of plants. Most are unaware of the pain they are causing themselves, because they eat them so often, and because the inflammation & ache are delayed up to 24 hrs.

Tomatoes
Potatoes (Sweet potatoes and yams are ok)
Peppers, including spicy, chili, and bell peppers, and paprika (Black, white, and green pepper is ok- it’s actually a peppercorn. Long pepper is ok, too.)
Eggplant
Tobacco

Although less well known, Goji berries are nightshades, too.

Note: Blueberries, huckleberries, artichokes, and okra are not in the Nightshade family, but they also contain solanine.

The good news: It’s very easy to find out if you are Nightshade sensitive. Simply remove all of them from your diet for two weeks. Then have a big dose of tomatoes, potatoes, or drink a V8. See how you feel that evening and the next day. If within 24 hrs your pain is worse, you are Nightshade-sensitive. Wherever you have inflammation, that’s where it will show up. If not, congrats – you can go back to all the tomatoes you want.

The alkaloid is degraded by heat. Raw Nightshades are more toxic than cooked, and the extreme heat of deep-frying is even better … but fried foods are inflammatory for other reasons, so don’t get too excited. I will eat a small amount of potato chips on a special occasion because they are fried all the way through, but not french fries, since they are still squishy in the middle.

The combination of Nightshades and sugar is a doozy. I can get away with a small amount of tomato paste, but even a tiny squirt of ketchup will make my hands ache the next day.

Following an anti-inflammatory diet is a relatively simple way to decrease your pain and make a real difference in your quality of life. Some people have inflammatory reactions to dairy or wheat, and that may be worth testing the same way as the Nightshades. You don’t have to be perfect all the time – just pick your battles, okay?

Here’s a nightshade-free curry recipe and one for non nightshade Mexican. Substitute either cauliflower or sweet potatoes for regular potatoes. Pizza and pasta are great with pesto sauce. There’s even a “No-Mato” marinara sauce I just found online (OMG SO GOOD!!!! I used the higher levels of spice for everything and loved it!).

UPDATE 4/29/16: Now that I’ve been Nightshade-free for a decade, I’ve found that I can get away with cheating once in a while. There seems to be a cumulative effect. By staying away 99% of the time, and preventing a build-up of inflammation, I can enjoy the occasional indiscretion. 

*Diet soda is bad too. While it doesn’t contain sugar, the artificial sweeteners cause their own problems, including triggering the body to start storing more calories as fat.

Quit Smoking with Acupuncture

IMG_20160709_105847My paternal grandfather smoked himself to death when I was 3 years old. I only have one memory: His face as he was picking me up. My beautiful, amazing Grandma was lonely for 38 years until she passed on. She also suffered from emphysema, although she never smoked herself. Because of them I am determined to help you quit smoking, and it really is free. There’s no purchase required or other hidden charges. I pay my rent by treating other conditions, but this I do simply because I am passionate about it. All I ask in exchange is that you respect my time and efforts, and keep your appointments. Last minute cancellations and no-shows will be charged a missed appointment fee, just like my regular patients.

Here’s the scoop: Using acupuncture on the ears and wrists speeds up the detox aspect of quitting. The nicotine flushes out of your system more rapidly, leaving you with less irritability, fewer jitters, and reduced cravings. It won’t make you want to quit, but it will make quitting easier. I’m going to show you a few things about the effect of smoking on your body you may not know about, explain the process, then we’ll get to the good stuff: 10 tips to help you toss out the cancer sticks for good!

WHY QUIT?

Nearly every single disease you can ever contract will be worse if you are a smoker (because your body can’t get enough oxygen to fight back), and your odds for getting these illnesses is vastly increased if you smoke. Seriously. It’s time to quit!

In case you need a few more reasons:

Twin B is a smoker and sunbather.

Lung cancer gets all the press, but nicotine destroys all the capillaries in your body. Capillaries are how blood actually gets to and from your individual cells. As a result, all of those cells are suffocated by a lack of oxygen. Decreased blood flow also means they can’t “take out the trash” so waste products collect. That’s right, smokers, your cells are sitting in their own poop. Wounds are slow to heal. Infections are harder to beat. Your skin turns to leather. Your bones are weakened and make you more prone to osteoporosis. The same process that strangles cardiac blood vessels and causes heart attacks will cut off blood flow to your extremities, and many men suffer impotence.

photo_of_osteoporosis


smokerslungsSmoker on the right. Note the difference in bone density, and the enlarged heart!

In cases of very heavy smokers, Buerger’s disease can make your fingers fall off. I’m going to be nice and not include a pic here, but Google it if you’ve got a strong stomach.

We’ve known for a long time “that thousands and tens of thousands die of diseases of the lungs generally brought on by tobacco smoking. . . . How is it possible to be otherwise? Tobacco is a poison. A man will die of an infusion of tobacco as of a shot through the head.” —Samuel Green, New England Almanack and Farmer’s Friend (1836).

And that was before cigarette companies started adding caffeine, carbon monoxide, nitrogen oxides, hydrogen cyanide and ammonia. Forty-three known carcinogens are in mainstream smoke, sidestream smoke, or both.

And if you’re pregnant? Wow. 

WHAT SHOULD I EXPECT?

The 5NP (5 needle protocol) ear acupuncture is used to speed up the physiological aspect of detox from all chemical addictions. In addition, there are specific wrist points to help you quit smoking. Your cravings, irritability, and jitters will be much reduced by the acupuncture. I was trained in this system by David Eisen, one of the founders of NADA (National Acupuncture Detoxification Association), and honed my skills by volunteering at PAHC (Portland Alternative Health Center) working with post-acute withdrawal patients.

Acupuncture won’t make you want to quit smoking, it just makes the quitting easier. You should taper down and be ready to quit at your first appointment, even if your last cigarette was only a few hours (or minutes) earlier.

The needles I use are sterile, single-use disposable ones. They are only about the thickness of a human hair and relatively painless. The needles stay in for about 20 minutes. The acupuncture session by itself is very powerful, but I can also give you ear seeds on those points to take home. These are radish seeds on tiny squares of band-aid type tape, for acupressure on the detox points. If you’re needlephobic, we can skip the acupuncture and just do the ear seeds.

Ear acupuncture is relaxing and powerful!

Ear acupuncture is relaxing and powerful!

Ideally, I’d like to treat you three times over about a week. At that point the tobacco is pretty much out of your system, so the physiological part of the addiction is over. You will still have challenges with the psychological addiction, and it can take up to a year for your brain chemistry to return to normal. In the meantime you might feel foggy-headed as your neurons repair.

It won’t be easy, but it will be doable! If you need “booster” treatments I’ll be happy to provide those, too.

Quitting smoking really has two parts.

One is the habits and psychological addiction. Reading this article should help with that. It won’t be easy – I can’t make you not WANT to smoke – but following this guide will make it easier to put up a fight.

The other is the physical addiction to the nicotine. Some people prefer to use gum (or patches) to split this into two separate battles. If you want to get over the habit part using a different delivery method for nicotine, then use me to ditch the nicotine afterwards, that’s a perfectly valid plan. It still counts as an effort to quit smoking and it’s still free. Since the point of the acupuncture is to get toxins (including prescription drugs) out of your system, however, seeing me is NOT COMPATIBLE with using Chantix, patches, e-cigs with a nicotine cartridge, or nicotine gum.

quit smoking acupuncture

WHAT ELSE CAN I DO?

Here are 10 tricks you can use to make quitting easier.

1)    Find a substitution. This can be as simple as a 3 inch section of a plastic drinking straw for your fingers to play with. The people who do best tend to be those who pick up a new hobby, or reinvest in an old one. It doesn’t matter what you do. Build a model train set, or sing, or scrapbook. Play a game on your phone (My favorites right now are Zen Koi and 1010). I’ll be thrilled to teach you how to knit. I’d love for someone to take up the harmonica – it’s portable, and uses your mouth and hands. But simply going for a stroll around the block would probably be easier on the ears.

2) Identify your triggers. When do you tend to smoke? Figure out a way to break the rhythm of those habits.

In the car? Completely Febreeze & detail your interior to reduce the smell. Instead of lighting up, rock out with the radio. Put your windows down – or up – whatever’s different.

On break at work? Go for a quick walk around the building.

When you’re drinking? Try going out to non-drinking events instead (movies, dinner at a smoke-free restaurant, etc) or at least hang out with non-smoking friends.

You get the idea… come up with a way to change your patterns. The trick is to be ready with an alternative, so you don’t default back to smoking because you can’t think of something else to do. Going for a walk around the block is always a great substitute and will help avoid weight gain.

3)    If you used to smoke when stressed, focus on new ways to relax. Visualizations can be very helpful. Try some Deep Breathing techniques. Every time you want a cigarette, do this instead: Close your eyes. Inhale the deepest lung-full of air you can. Really fill up your chest. Exhale very slowly. Visualize all the tension leaving your body, slowly draining down your body and out of your fingers and toes.

Repeat that three times (at least). With some practice, you’ll be able to use it to deal with terrible bosses, screaming children, or those ever-vigilant tow-trucks.

4)    Consider finding a sponsor (think AA). This can be someone who quit in the past, or someone who’s just determined to help you. Call them when your cravings get bad, 24/7, and they’ll help divert you by reminding you of all the reasons you decided to quit.

5)    If getting mad will help you stay strong, think about those rotten tobacco companies and how they’ve been knowingly profiting from people getting sick for years. Refuse to give them any more of your money!

6)    Remember that both tobacco plants and cigarettes have been engineered for decades to maximize your addiction. It’s actually harder to quit smoking than heroin! Understand that it’s okay if you aren’t perfect. Most people need a few tries to quit for good. Just keep on trying! Identify why you slipped and build a better strategy (or reinforce your old one so it’s stronger). Learn from your mistakes… and pretty soon you’ll be smoke-free and happy!

7) Eat your veggies! Previous data has shown that smokers tend to consume fewer fruits and vegetables than non smokers. It turns out that certain foods actually make the taste of cigarettes worse – especially milk, dairy products, and fruits and vegetables– while, coffee, red meat and alcohol make cigarettes taste better. Studies further suggest that cravings for food and cigarettes are likely linked and often confused with one another. So one thought is that eating a diet with higher fiber content may actually make you feel fuller and prevent such “craving confusion” from developing. In practical terms, however, individuals who consume more fruits and vegetables are probably more health conscious and thus more likely to quit smoking overall.

8) Drink a lot of water. Your body will be going through a heavy detoxification. Help it out by diluting your system with a few extra glasses of H2O. Caffeine and sodas are diuretics (they make you pee) so you’ll need some extra water if you have those as well.

9) Wait 5 minutes if you get a craving. Just hold on… most sudden pangs of desire will fade as soon as they come on. Distract yourself for 5 minutes… 10… suddenly 20 has gone by and you’re just fine. :)

10) Remember that you only get this one body. You can’t trade it in, and you can’t buy a new one. You HAVE to take care of the one you’re wearing, because hopefully you’ll be around for a while, and Future You is going to want to look and feel as good as possible.

More Info on building your Quit Plan

1) Determined to Quit

2) Anti-Smoking.org (includes some fun advertising info)

Online Support Forums / Communities

1) Quitza

2) Delphi Forums

3) Web MD

4) http://www.theeasywaytostopsmoking.com/

Sleep

Lack of sleep in the middle of the night isn’t always a bad thing, but it sure can be. Insomnia is maddening… it starts out irritating or boring, but over time it affects your energy, your memory, and even your sanity. If you’re having trouble sleeping, try these tactics before resorting to an artificial sleep aid.

images

 

Bedtime patterns: Teach your body how to relax and prepare for sleep at bedtime. Build a ritual of activities that you do every night. These should be low-key: Save the heavy exercise for the mornings. Relax for twenty minutes. Meditate. Take a hot bath or a slow stroll around the block. Knit, read, work on your model trains… whatever makes you feel peaceful and happy. This should not take place in the bedroom.

Timing: Try to go to sleep at the same time every night, before 11 pm. If you are having trouble with your sleep, get up the same time every morning, too (yes, on weekends!) to reinforce the training. If you find yourself awake at night, relax your body and try to drift off. If you can’t, get up rather than stare at the ceiling. If you think it’s possible to fall asleep, repeat your nighttime ritual and go back to bed. If not, do something else until you start to feel sleepy.

Avoid “screens” at night: Light stimulates the pineal gland (It’s daytime!). In the dark, the pineal gland produces melatonin, which helps you sleep. Watching TV or checking your email one last time before bed can be counterproductive. Note: Use this free app for your computer (Mac or PC) or iPhone to reduce visual stimulation after sunset!

Environment: The bedroom itself should only be used for sleep and sex. Prepare your space for restful sleep. If there’s a TV in there, take it out. It should be quiet. If you cannot achieve quiet, try some white noise from a fan to block out background chatter. The key here is to eliminate sensory stimulation. Likewise, your bedroom should be dark. Use opaque curtains or a blindfold if necessary. Personally, I use an eye-pillow. It blocks all ambient light, and the gentle pressure feels great. Blocking light is important because it allows your brain to generate melatonin (see above).

Exercise: Stimulating your metabolism through exercise is a great way to make you more awake during the day, and sleep better at night. This doesn’t have to be an epic weight-slamming workout – even a walk will help. The best time to get moving is the morning. Doing it just before bed will raise your adrenaline levels and make it harder to sleep.

Reduce caffeine: Try to limit your intake during the day and avoid stimulants after 6pm. This includes caffeinated soda and chocolate (sorry!). One Hershey’s kiss won’t make or break you, but use your common sense. Green tea contains less caffeine than black tea, and herbal tea is usually caffeine-free.

Percy, one of my former nocturnal visitors.

No disruptive pets in bed: I hate to admit it because I miss sleeping with my boys… It’s so sweet when they wake you up to tell you how much they love you. I miss their warm furry purring bodies… But I’m sleeping so much better now that we’re kicking them out of the bedroom at night. No wonder I felt exhausted for years! Brushing teeth in the morning is a challenge, though, because they can’t get enough affection and basically leap into my arms.

Give your sleep some respect: I have people tell me they are too busy to sleep and they can’t stop working, but they need to remember that a tired brain is not efficient. Your memory and decision-making will suffer with sleep deprivation. Extreme exhaustion will literally turn a sane person into a temporary schizophrenic. Getting sleep is your job if you want to be productive!

Consciously relax: Breathing techniques and visualizations can be very helpful. Go to your happy place. Allow your body to go completely limp and imagine sinking into the mattress.

Acupuncture can be an invaluable tool in getting your sleep back on track. There are some specific points that help sleep. I also have a great treatment called Stroking the Dragon that stimulates the parasympathetic nervous system. It’s terrific as an evening housecall. My patients tend to mumble “let yourself out…” into their pillows, and I hear snoring before I get out the door. :)

Acupressure for yourself! Try Du-20 & 24 as a simple combo. Du 20 is at the crown of the head, above the ears. Du 24 is half an inch inside the hairline (or where it used to be!). Put a fingertip on each, aimed towards each other, and press firmly but gently for a few seconds. Good night!

Press these two points gently but firmly, towards each other, for a few seconds at bedtime for better sleep.

Press these two points gently but firmly, towards each other, for a few seconds at bedtime for better sleep.