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, giggling, getting 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

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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. This is one of the reasons why I’m not a fan of the Daith piercing. 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. Shen Men is a terrific point, and I think his instinct to stimulate the point was a good one, but he went about it the wrong way. Having a large piece of metal blocking the point 24/7 can actually cause more problems.

Where are your piercings?

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

I’m not anti-body-modification. In fact, I have an 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.

* The Ren channel starts at the perineum and runs up the front of your body. It’s important in fertility and to nourish your muscles. After my car accident, I found that Ren energy was getting trapped by the belly ring, causing tenderness when I pressed below it. When I removed it, the pain went away instantly, and my healing accelerated.

**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. This is an ancient system, built before a modern understanding of physiology.

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!

Everyone is different, of course, but I am here to tell you that most people CAN reduce or even eliminate Fibromyalgia symptoms. I used to be in a lot of pain… Now, as long as I am reasonable with my diet and exercise, my symptoms are very mild and very manageable! Let’s see how much progress we can make.

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. If all you can do is make snow angels in bed, do that. 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 most people with FM tend to be sensitive to their natural alkaloids. This article contains full details and some recipes. 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. Alternatively, you can use a quick blood test to identify foods your body reacts to – I can do that in the office, so ask me if you have questions.

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. I prefer myofacial release (MFR) 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. Careful medical massage techniques, including MFR, use a large contact (palm of the hand) instead of a pokey one (fingertips), and are wonderful for helping disperse blood and lymphatic stagnation. If there’s a partner in your life, I can teach them how to work on you. I am also conservative in my needling for FM patients. I use the skinniest possible (42 gauge) and just a few… too many can wipe out your energy.

Acupuncture: Acupuncture and Chinese medicine provide relief of symptoms by balancing Yin and Yang, and adjusting the circulation of Qi and the blood. A regular plan, with long-term, consistent integrative treatment is necessary in patients with fibromyalgia. See the patterns of FM as understood by Chinese medicine, listed below.

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 a daily diary that tracks your food, activity, and symptoms will help you identify patterns.  

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

A 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, lack of libido, or infertility issues. 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 Post-Stroke Spasticity (contains Chinese medicine theory)

If you are interested in a personal coaching session for stroke recovery, which would include teaching you or a caregiver acupressure and therapeutic exercises you can do to speed healing, you can schedule a telehealth appointment here! Please note I am in the Pacific time zone. 

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.  

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. Good fats (avocado, nuts, seeds, fish, coconut oil, extra virgin olive oil, etc) are essential to support nerve repair. Eat lots of veggies, cooked so you get more nutrients out of them, and  good quality protein (grass-fed / pastured animals). 
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.
13)Kjendahl A, A one-year follow-up study on the effects of acupuncture in the treatment of stroke patients in the sub-acute stage: a randomized, controlled study, Clin Rehabil. 1997 Aug; 11(3): 192-200.
14)McGuire JR, Harvey RL. The prevention and management of complications after stroke. Phys Med Rehabil Clin North Am. 1999;10:857– 874.
15)Maciocia, Giovanni. The Practice of Chinese Medicine, 1994, Churchill Livingstone.
16)Marieb, Elaine. Human Anatomy and Physiology, 4th Edition, 1998, Addison Wesley Longman
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
20) J Pei. The effect of electro-acupuncture on motor function recovery in patients with acute cerebral infarction: a randomly controlled trial. J Tradit Chin Med 2001 Dec;21(4):270-2
21)Simpson D, et al. Botulinum toxin type A in the treatment of upper extremity spasticity: a randomized double-blind placebo controlled trial. Neurology. 1996; 46:1306 –1310.
22)Simpson, David MD, Professor of Neurology, Mount Sinai School of Medicine, and Jean-Michel Gracies, MD, Mt. Sinai School of Medicine, as cited on www.poststrokehelp.com
23)Stamenova, P. A randomized, double blind, placebo-controlled study of the efficacy and safety of tolperisone in spasticity following cerebral stroke. European Journal of Neurology, 2005; 1 QA2 (6): 453-461).
24)Steultjens, Esther MA et al. Occupational Therapy for Stroke Patients. Stroke. 2003;34:676-687
25)Wallace JD. Summary of combined clinical analysis of controlled clinical trials with tizanidine. Neurology. 1994;44(suppl 9):S60 –S69.
26)Werner, C. 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.
27)Weimar C, et al. Assessment of functioning and disability after ischemic stroke. Stroke. 2002;33:2053–2059.
28)Wiener, J et al. Measuring the Activities of Daily Living: Comparisons Across National Surveys, Journal of Gerontology: SOCIAL SCIENCES (November 1990, Volume 45, Number 6, pp.S229-237).
29)Wojner AW. Optimizing ischemic stroke outcomes: an interdisciplinary approach to post-stroke rehabilitation in acute care. Crit Care Nurs Q.
Sharon Rose, L.Ac. Acupuncture and Post-Stroke Spasticity 20 1996;19:47–61.
30)Wong, AM Clinical trial of electrical acupuncture on hemiplegic stroke patients. Am J Phys Med Rehabil 1999 Mar-Apr;78(2):117-22.
31)Wu, Yan. Practical therapeutics of Traditional Chinese Medicine, 1997, Paradigm Publications.
32)Young RR. Spasticity: a review. Neurology. 1994;44 (suppl 9):S12–S20.
33)Young RR. Physiologic and pharmacological approaches to spasticity. Neurol Clin. 1987; 5:529 –539.

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, coconut oil, avocado, salmon, nuts & seeds) 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. Inflammation in the gut will encourage inflammation all over the body. NOTE: I now have access to blood testing (we prick your finger in the office and send off a blood spot card) that can identify which foods you’re reacting to. This is incredibly helpful and much easier / faster than a thorough elimination diet.

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, cherries, apples, sugar beets, 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 You’ll have to read labels carefully. “Spices” may contain paprika, and lots of prepared foods like shredded cheese can contain potato flour, labelled as “cellulose.” After two weeks of avoiding them, have a big dose. Enjoy that eggplant parm with marinara sauce, a pile of 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 extreme heat. Deep-frying will destroy solanine … 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?

Spicy food junkies: Fear not! You can still enjoy horseradish & wasabi, onion, garlic, ginger, and all the peppercorns, including long pepper.

Here’s a nightshade-free curry recipe and one for NonNightshade Mexican. Substitute either cauliflower or sweet potatoes for regular potatoes. Pizza and pasta are great with pesto sauce. There are wonderful southern vinegar-based BBQ receipes. There’s even a “No-Mato” marinara sauce I found online (OMG SO GOOD!!!! I used the higher levels of spice for everything and loved it! If you use all regular beets it’s purple. If you use 50% regular beets and 50% golden beets, you’ll get a red sauce with a less “beety” taste. Freezes well, too!).

Like to eat out? Free restaurant cards are here. 

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. UPDATE 9/23/21 This is more and more true as time goes on! I can even indulge in big cheats once in a while, but that was after 15 years of abstaining. Be patient! <3

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

Note: Biodegradable drinking straws are becoming popular here in Portland, and some are made with potato. It’s a small enough amount it may not be a factor for you, but if you are highly sensitive, start carrying your own collapsible straw for eating out.

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 the nicotine out of your system, this treatment 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/

I smoked on and off for 20 years. When I finally quit for good, it was with the advice of someone from a 1-800 quit line that I was required to go through for my work.  I explained to the gal that I would quit for years at a time and then go back to it. She asked me what it was about it that made me go back to it. I explained to her that I would think that I could have just one, or just a drag...  She told me there is a science behind why we end up exactly where we started (like if we were a pack a day smoker, we end up back at a pack a day). She explained that the body has transmitters that process nicotine, and that the longer we smoke the more prolific those become. That way we can process the nicotine more efficiently.  Then she told me to imagine those transmitters are like toddlers. You've got this room full of toddlers. You quit smoking, you finally get them *all* down for a nap.  What will happen if you wake one of them up (with "just one" drag/smoke)? It will wake up the rest of them! And they will be grumpy and hungry and demanding.  For some reason this visual works for me. Anytime I get tempted to have "just a drag", my mantra is "DON'T WAKE UP THE TODDLERS!"

Detox your body and spirit

(written Jan 2012)

It seems like every January, people ask me about detoxification programs. That makes sense. We live in a pretty dirty world, in terms of chemical pollution. There are hormones and horrifying chemicals in our food. And of course our heads are full of unhealthy thoughts. How do we take an internal shower? Here are some ideas for both physical and emotional detoxing.

I was fortunate to have the opportunity to learn detox strategies from David Eisen, the co-founder of the National Acupuncture Detox Association, while volunteering at the Portland Alternative Health Center (now Central City). After addicts got past those worst few hours of stopping drugs, they came to us. I treated people getting clean from crystal meth, heroin, PCP, and alcohol. All of these cases had one set of ear needles in common, the 5 Needle Protocol. 5NP uses points that calm agitation and to speed up the body’s process of filtering out toxins.

We can also use 5NP to clear out pollutants like mercury and pesticides. In my Pennsylvania clinic, it was shockingly effective in relieving pain for a patient who had a bad reaction to a statin drug. Here’s her story:

“I was in terrible pain due to an adverse reaction to a new prescription from my doctor. I hadn’t slept in four nights and I was taking 800 mg of Motrin every four hours to no effect. My doctor ordered blood tests and ruled out other causes and wanted to give me Percocet for the pain. I knew from experience that I would react badly to Percocet. I left the doctor’s office with no hope and a possible referral to a busy rheumatologist who could see me the following week. I knew I’d never make it. I called Sharon Rose. She made a house call and saw me that afternoon. Immediately, I was free of pain and slept that night. After 12 hours, some of the pain and swelling returned but with treatments from Sharon every other day I was soon totally off the Motrin, free of pain, free of swelling, and feeling the best I’ve felt in years.”

This same detox protocol, combined with two specific wrist points, are my smoking cessation treatment. By getting the nicotine out of the system more rapidly, it helps reduce the “jitters” and irritability, and decreases cravings. Remember that I am happy to help anyone quit smoking for free – so tell your friends if they’re still hooked. I’m here when they’re ready.

Okay  – so that’s the physical side. What about mental and emotional toxicity? Negative thought patterns, like prolonged fear and anger, will poison us just as surely as hemlock.

Take a minute to ground yourself. Ideally, you should lie down in a quiet place and consciously relax. I love to teach my patients the French Press visualization (now is when you have to pardon me for the “grounds” pun).

French Press

French Press: Filter out the bad stuff!

Imagine you’re that cylinder, with the filter at the top of your head. Slowly move it down, trapping all the bad stuff as it goes. Clear your mind… all the tension & pain is yucky black goo getting swept up by the filter. Above it, you are clear, relaxed, happy. Gradually move that filter down your body, focusing on each level. Neck, shoulders, back… with each inch, more toxins are ensnared. Finally, you will have a clean, healthy body with all the bad stuff stuck at the bottom. If the French Press doesn’t float your boat, be a tube of toothpaste and squish the goo out. I don’t care what image you use as long as it works for you. Here’s the important bit – push it out of your body through the bottoms of your feet or the tips of your toes (Note: Don’t do this with a pet sitting at your feet – they are sensitive to energy work).  Repeat as necessary.

6209734716_88e1482ece_mYou can also imagine yourself floating in a magic stream, with your head upstream. The water is flowing through you, washing away all the pain, tension, disease… all the bad stuff… it just gets swept away by the cleansing water moving through you.

The quickie version, at work or when there’s a houseful of screaming kids and bickering relatives: Go to the bathroom, shut the door, and take a deep breath. Sit down for a second and do a mini version of the filter technique. You’ll be amazed at how well it works with just a little practice.