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Pediatric Acupuncture

November 28, 2011 By Leave a Comment

One way to build an acupuncture practice is to specialize.  Many practitioners struggle with specialization, others know exactly what they want to specialize in and some, like Robin Green, LAc, find a problem and become a specialist by solving it.   Morgan Hill Family Wellness Acupuncture and Herb clinic treats all family members, including children.

Not all acupuncture schools discuss treating children in their programs, although pediatrics is getting more popular.  Robin says she wasn’t all that interested in treating children when she was in school.  Her interest began in her first year of practice.  Of course, she may have been pushed towards this when her infant son had an issue with eczema that just wouldn’t resolve.

Robin says, “None of the conventional medical treatments we tried worked to treat his eczema, instead by the time he was nine months old, it got worse spreading throughout most of his body   At that point, I decided to do some training in holistic pediatrics to see if I could help him with acupuncture and herbs.   In the process of helping him, I began to share my son’s story with my patients and they started bringing their children in to see me.  That is how my pediatric practice began.”

Needles are such an issue to many adults and to children of a certain age.  People don’t realize that acupuncture needles are not the same the syringes they are thinking of. However, Robin says children under about 15 months of age haven’t developed that fear yet and she is able to do quick treatments that get rapid results.  As children grow with acupuncture as part of their lives, they are less likely to fear the treatments even when they are older.  Robin says she is able to do treatments that prevent imbalance rather than try and heal it after it has developed.

Interest in pediatric acupuncture has grown in the last few years.  Robin says, “The pediatric acupuncture field had grown significantly in the last decade.  This is due in part to more research that has shown benefits for pediatric pain management. About 40% of all pediatric hospitals now offer acupuncture for pain management.  It seems like monthly there are more and more articles published in magazines, newspapers and on television about the benefits of acupuncture for children.  Also, parents use the same treatments on their children that work for them.  Once parents understand how acupuncture is safe, painless, and effective acupuncture is for themselves they often bring their kids in too.  ”

Of course, pediatric acupuncture isn’t all about pain management in an acupuncture clinic.  Robin sees patients for low immunity, eczema, asthma, allergies, coughs, bronchitis, sinusitis, colds and flus as well as anxiety and digestive disorders.

Besides the fear of needles, another issue with pediatric acupuncture is the relationship issue.  The practitioner has to relate both to the child and the parent and be trustworthy in the eyes of both.  Establishing these multiple lines of trust can take some thought.  Robin says, “In kids under age 8, most parents stay with their child during treatment.  Occasionally, it’s easier to help a child with sensory or ADD issues alone in the treatment room while the parent waits in the waiting room.  After age 8 about, 50% of the parents stay in the treatment room.  When I treat kids without their parents present a lot them open up to me and tell me about things that go on in school or home that they may not have shared with their parent present.  Many parents are relieved that their child has another adult to confide in and notice a difference in compliance with the child’s treatment plan.  Teenagers are mostly likely to want to tell me things they don’t want their parents to know.  Anything they say to me is confidential unless it would cause harm to themselves or someone else and once they know that many of them open up to me.  I often have parent tell me about the bad behaviors of their teen (staying up too late, not eating well, drinking to much soda, etc.) that they need help getting through to them about.  Being their acupuncturist means I can discuss these issues and help them make better choices and take the pressure off the parents.”

Given the special needs of the very young and the need for an acupuncturist to think very carefully about their relationship to different people in the patient/practitioner relationship, I asked Robin what she would recommend if someone was thinking of specializing in pediatrics.  Robin says, “Specializing in pediatrics takes a lot of extra training to attain the expertise needed to confidently address the myriad of health issues and patient-parent issues seen in pediatrics.  I would recommended taking as many pediatric acupuncture courses as possible, taking a physical exam and red flags trainings and get clinical experience observing someone who specializes in pediatric acupuncture.”

Recently Robin has had an article on pediatric acupuncture in Acupuncture Today and is working on increasing her pediatric patient load.  She has another colleague in her office that sees adults.   Robin also says, “My larger vision is to help the acupuncture pediatrics field grow so that all practitioners could get the training they needed to confidently see children.   I would also like to write a practical guide to acupuncture pediatrics for practitioners and parents, teach acupuncture pediatrics to other practitioners.  My first step in that direction is my new blog, KidsLoveAcupuncture.com and I’m going to have my first externship at my office soon.”

I ran into Robin online as she worked on her first website years ago.  I was struck by how she had a very clear sense of what she wanted from her site and was very adept at getting it done. Her design choices were simple and elegant and really seemed to highlight who she was as a practitioner.  I asked her what her marketing experience had been.  Robin worked at health clinics while going through college and watched what those practitioners did.  She gets most of her patients through word of mouth and patient education.   She says she does this “without the qi talk”.  Anyone who reads my blog regularly knows she is preaching the choir here.  If you haven’t checked out Robin’s sites, I highly recommend a visit.

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James Rohr on Tungz!

October 25, 2011 By Leave a Comment

Acupuncturists are not often computer fans. In fact, a lot of practitioners eschew technology and are quite proud of it.  A few of us embrace it. As much as I love the internet and can make a good website, I have to say I’m blown away by self taught app developer, and acupuncturist,  James Rohr. Rohr’s application is called Tungz!.  Available for android or the iphone, as well as the ipad,  Tungz is a great way for lay people to get a look at what a healthy tongue does and does not look like.

Rohr says, “ I’ve been giving lectures on tongue assessment for many years now, and I thought the subject matter would lend itself to a nice app.  I’m a big fan of technology and education, so this app is a natural combination of those two interests. ”

I found out about Tungz! when Rohr mentioned it in an online group for acupuncturists.  As I went to check it out, I was expecting something for practitioners, but it’s actually an introductory tongue evaluation for patients.  Rohr says, “Because of the ease of use and the accessibility of the pictures, I actually think this app will be a great tool for practitioners to share with their patients to help build their practice.  How many times have we heard someone say, “I’m healthy.  I don’t think I need acupuncture.”  Practitioners know that Chinese medicine has a very narrow view as to what is actually healthy. A quick glance at a tongue and comparing it to the healthy pictures can show the potential client right away if their tongue shows imbalances.  Another thing I hear quite a bit in my practice is “I love the treatments and I think my _______(husband, wife, children, co-worker, etc) could really benefit, but they don’t think they have anything wrong with them. What can I do?” If the patient has the app, they can show the app to the person they want to refer and if the tongue is different, the prospective client can see for themselves that their body is sending a signal thru the tongue that their Qi is not in harmony.”

One challenge in creating the application was getting good clear pictures of tongues.  Not only can flashes drown out color but quivering tongues are often blurry.  Rohr has asked for people to send in more photos of their tongues and the response has been good.  One person said, “Wow, do you also read minds? :)  I was quite impressed with what you said about my health by one single look at my tongue!!”

Rohr has been in practice since 2005 after graduating from Pacific College of Oriental Medicine.  He has also trained at Chengdu University. Lest you think his background was in computer science, Rohr has an undergraduate degree from Stanford in anthropology.  Rohr taught at Pacific College of Oriental Medicine at their Chicago campus.

Rohr now works at an integrative health center in Florida and divides his time between that and private practice.  His areas of interest lie in treating stress related disorders and “chronic conditions”. If developing apps and acupuncture aren’t enough, Rohr also has a line of organic teas, designed around tongue diagnosis.

Reading about everything Rohr has going on, I  had to wonder what’s next.  Rohr says, “I’ve just opened a new clinic in South Beach here in Miami, FL. I’m very excited about the new space.  I’m also working on a book about rethinking chronic illness. I hope to have that out sometime in 2012. I’ve also launched Tungz Teas, a line of organic teas using some western and eastern herbs in formulations to help support people’s constitutions. For the uninformed, there are some great tasting teas. For the eager and educated patient, there is the option to search for teas based on tongue features. I’m excited to see how this business grows in the coming year.”

Check out the Rohr’s websites for his app as well as his line of teas. The teas integrate well with his Tungz. He’s definitely a practitioner bringing this ancient medicine into the digital age.

 

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Acupuncture at the Zoo

August 22, 2011 By Leave a Comment

Maryland acupuncturist, Tom Igegno,  had a patient not everyone gets to see.  Tom got to treat a giraffe.

Although many states require an acupuncturist to be a veterinarian or practice under one Maryland defines the scope of practice as sentient beings rather than humans. Practicing on animals requires an animal certification. Getting certified includes taking  an animal acupuncture course at Tai Sophia. Veterinarians are still required to see the animal with in two weeks prior to treating and communication must be left open with the vet.  While the certification is normally just for companion animals, Tom was able to treat the giraffe because he was working under supervision.

A patient of Tom’s worked at the zoo where Gretchen the giraffe was housed. Gretchen was 23 at the time, which is quite old for a giraffe in captivity.  Gretchen had a lot of joint problems.  Her hoofs were misaligned and the veterinary staff suspected she had arthritis because of that.

By the time Tom was called, the zoo was hoping for hospice care in keeping Gretchen as comfortable as possible for as long as possible. Gretchen’s difficulties were exacerbated by the fact that it was a particularly rainy summer and her symptoms were worse when it rained. She did well for her treatments but often the symptoms came back with the next rain fall. On her bad days, she could barely walk and refused to eat.  Immediately after treatment, Gretchen’s appetite picked up substantially. She often started eating during treatment.

Asking about Gretchen’s diagnosis, Tom replied, “ I practice Japanese meridian therapy, so I diagnosed her as KI deficient.  I suppose a good TCM dx would be Ki Yin def, with localized hot damp BI.  Either way, we treated quite a few points on the KI/UB channels focusing on UB23, Ki3,6,7.  Then of course treating the joints locally.”

Although the zoo keepers felt that Gretchen improved post treatments, she was a geriatric giraffe and it was felt that keeping her alive past a certain point was cruel. Her time came about three weeks after treatments were started. Upon necropsy it was found that the major joints in all four limbs were worn almost flat. Tom says, “ I believe that the zoo’s staff had made the most compassionate decision they could have.  ”

While the zoo keepers were initially skeptical of Tom’s work, his patient gave such glowing recommendations they were willing to try it.  The compassion these people had for their charges and their willingness to try just about anything that might help left them open enough to notice the improvements Gretchen made during and after treatment.

So how does an acupuncturist needle a giraffe?  Tom says, “The biggest challenge was getting around her. The zoo knew that Gretchen was going to have issues as she grew. They spent a massive amount of money making a “Giraffe Restriction Device” specifically for her. It looked much like those boxes that the magicians’ assistant goes into to be cut into pieces except much larger. There were doors at different levels going from her hooves to her neck that could be opened on all sides and about 6 different levels gain access to each area of her body. There were also heavy duty padded straps that would go under her body to help give her some support and take weight off of her joints.  She actually enjoyed being in the unit. It did require quite a bit of climbing and reaching to get to some areas.”

Of course, Tom was unable to take the pulse in the femoral artery as would be usual in animals.  Apparently getting kicked by a giraffe sounded less than pleasant to him.

While it was a fascinating experience, it’s not one that’s likely to be repeated.  Zoo animals, however fond their caretakers may be, are first and foremost wild animals. As such they must be treated with caution. Acupuncture isn’t meant to be done while an animal is anesthetized and it’s unlikely that the average zoo animal is going to sit around and wait to be needled.

Acupuncturists in other states who are interested in treating animals should find out their state’s policies on animal acupuncture. In Washington state, where I live, a practitioner must also be a veterinarian to charge for animal services. While many people feel very negatively about this, the veterinarians I have worked with have had excellent education and most have been very open to talking about acupuncture and herbal medicine with me. As a cat owner, I typically choose homeopathy for my cats and have the greatest respect for the work my vets do, using classical single formula homeopathy. I am fortunate to live by a clinic where all the practitioners have accumulated many hours beyond the minimum required for the modalities in which they practice.

Tom adds that some states have no legislation about treating animals. While this means it’s not illegal, it’s not legally recognized either.

Wondering what Tom does when he’s not treating giraffes? Tom has a busy practice in Maryland where he relocated in 2006.  Before that he had practiced in New York.  Tom has no real specialty, feeling that specializing might keep him from seeing and treating the whole patient.  He typically sees about 50 human patients and 10 animal patients a week.  The pets have to be limited as they require house calls.  If you need to contact Tom about Gretchen or any other area of his practice, you can find him at Ancient Arts Acupuncture. Feel free to check out Tom’s photos of working with Gretchen here.

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Acupuncture in Australia

July 20, 2011 By Leave a Comment

Amanda Tsangarides, an Australian acupuncturist was kind enough to answer my questions about acupuncture “Down Under.”  Amanda practices in Darwin, Northern Territory and has been practicing there for the past 7 years.

Like the United States and Canada, the most common business model is an acupuncturist practicing in their own clinic.   The multi-modality model where there are clinics offering a variety of complementary health services is becoming more popular there.    Acupuncture models are changing.  Amanda says, “In just the past year or so, we’ve had an acupuncturist do enough research in an oncology ward to demonstrate benefit of having an acupuncturist working in the hospital – it’s a very exciting step forward, but largely a rarity.”

Australia is working on guidelines for acupuncture licensing.  These are expected with in the year.  Currently, the professional membership association has determined that minimum requirements for membership  are  a three to four year program with a few thousand hours of clinical internship in the last year and half.   In addition, many students have the opportunity to do internships in a Chinese hospital which will increase their clinic hours.    If a practitioner wishes to have Private Health Insurance Provider status they must be a member of the professional organization.

Although practitioners can get Private Health Insurance Provider status, patients typically pay the provider but are then potentially eligible for rebates on their treatments, depending upon their level of insurance.  The government health system only pays for acupuncture if it is performed by a medical doctor.   Doctors can practice with a minimal amount of acupuncture training in Australia.

Amanda says she became interested in acupuncture when at the age of 12 she chipped her tail bone.   She was quickly pain free.   She was assisted through the hormonal changes of puberty through acupuncture and herbal medicine as well.   She decided from these early experiences that this was a medicine that she wanted to know more about.

Australia is such a diverse place that I asked where most acupuncturists were centered.  They are primarily centered in the more populated areas but people from rural areas often travel long distances for a variety of services.    In general acupuncture is well received and acupuncture clinics are showing up next door to invitro fertilization clinics.

In Amanda’s area, there are over 120,000 people and only six acupuncturists.  She says that specialization is not something that is needed with those kinds of numbers. Educating patients is a big part of her practice and people really value her efforts in supporting a smaller town where she provides a regular monthly service.   She has a wide network of complementary providers who work together to provide the best services and care they can for their patients.

All in all, the business of being an acupuncturist in Australia seems very much like the business of being an acupuncturist in the United States and Canada.

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Acupuncture in Canada

June 27, 2011 By Leave a Comment

During a discussion some of my readers expressed an interest in finding out about how acupuncturists practice in other countries.  This interview will be the first in an ongoing series of international acupuncturists interviews.

Dr. Kim Graham of Medicinal Roots Acupuncture was gracious enough to spend time answering my many questions with very detailed responses about acupuncture in Canada.  Dr. Kim, as her patients call her,  practices in British Columbia.   Her website identifies her as a Doctor of  Traditional Chinese Medicine and Registered Acupuncturist.  The Doctor of Traditional Chinese Medicine is only recognized in British Columbia.   Also,  only in BC is all of Traditional Chinese Medicine regulated although Alberta and Ontario also regulate Acupuncture (but not the whole scope of practice).

Physicians and dentists can practice acupuncture, and in some provinces they are required to have additional training.   Physiotherapists may practice acupuncture depending upon the province, but often limited to “dry needling” and supplemental insurance may not cover acupuncture done by a physiotherapist.   In regulated provinces Naturopaths can use acupuncture.   Nurses can perform acupuncture in all provinces except Quebec.   Chiropractors can use acupuncture in all provinces except British Columbia and Quebec.

Public healthcare is regulated by province and in BC a portion of the acupuncture cost may be covered by their universal coverage.   The coverage is only $23 and the practitioner has the choice to charge more per visit or just take that money.  Additionally the number of treatments covered is very limited and combined with other alternative therapies.   Supplemental insurance policies that cover acupuncture are not normally billed by the practitioner but by the patient.

Dr. Kim has worked in a variety of clinical settings, working at her own business and in an integrated health clinic.   She also does work at the Vancouver Coastal Health Authority where she is paid hourly for group treatments.    Dr Kim says, “I have had the unique opportunity to work with integrated teams of western medical professionals, chiropractors, physiotherapists, massage therapists and myself. It seems as though this is the current trend.”

Acupuncturists may work in any of the variety of settings that Dr. Kim describes however the most popular option is the solo practitioner with their own business.   I asked Dr. Kim how the schools treated business and marketing education.   “This is a subject that needs more attention,” Dr. Graham writes.  ”I am part of a team that has developed a new TCM program at one of the public colleges here in Vancouver and this subject has been made part of the curriculum.”

As in the United States, acupuncture is gaining popularity, although it is still often the medicine of last resort.

In reading Dr. Kim’s interview it seems acupuncturists face many of the same challenges as those in the United States.   Those wishing to practice in other provinces may face more challenges as they are not officially regulated and licensed.   In British Columbia it does sound like there is less paperwork involved with the submission of insurance forms for those on supplemental insurance.

The business model of the solo practitioner and the lack of marketing and business education seems to be a common thread in both countries as well.   There are practitioners in the United States, who like Dr. Kim, are taking it upon themselves to help new practitioners with the business side of their education, it seems as if this aspect of the training has a lot of work left to do.

 

 

 

 

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Behind Zi Zai Dermatology

May 18, 2011 By 3 Comments

As I explore other facets of life and consider how to keep acupuncture in my life as I move in a more creative direction, I’ve been looking at what other practitioner’s have done. I’m very interested in Diana Hermann’s Zi Zai Dermatology, not only because we graduated from Oregon College of Oriental Medicine at the same time but because I toyed with the idea of doing topical salves and soaps shortly after graduation when I discovered soap making.   I never pursued the idea but Diana has and with a passion.

Diana requested dermatology as a study when she traveled to China after graduation.   Diana felt that because Western medicine had so little to offer chronic skin conditions,  studying dermatology would be a great way to help a lot of people who otherwise wouldn’t get help for their health issues.

Diana has started out slowly, building her dermatology line in her “spare” time.   Diana describes her Zi Zai journey this way, “I started formulating and testing products in 2008 and that is the year I decided to make the herbal skin care products a real business, as opposed to a hobby or just making products for my private practice clients.   I incorporated in 2009, but it wasn’t until April 2010 that I officially launched the webstore www.ZiZaiDermatology.com and actually started selling the products to the public.  Growth has been slow because I still spend most of my time in my private practice.  I am making the transition to spending less time in private practice and devoting more hours each week to growing Zi Zai Dermatology.  I love love love making herbal concoctions and I am excited to be able to spend more time doing that.”

As time goes on, Diana would love to be able to focus her practice more exclusively on dermatology, facial acupuncture and a small handful of other conditions and be able to devote larger blocks of her time to her skin care products.  Anyone who follows Diana on Facebook knows that she loves making her lotions and potions.  Recently she has learned to make soap and is experimenting with formulas that can work in with the soap making.

In talking to Diana about her long term plan, what she’d most love to do is work out the ideas for her practice with the focus on dermatology and skin care and perhaps formulate that as something other clinics could copy using many of the products she has formulated.  Teaching and writing may or may not be part of the equation in the future.

For other practitioners dealing with skin conditions in their practice, Diana says, “..the biggest part of treating skin diseases with TCM is the use of internal herbal medicine…Everyone’s skin is different and proper differentiation makes all the difference in improving any skin problem.”

When asked specifically about her products, Diana says, “Zi Zai products are formulated according to specific TCM patterns and we offer multiple formulas when there are varying TCM patterns possible for a given skin condition (for example, we have 3 ointments for psoriasis and 3 ointments for eczema).  We offer 20% discount to all practitioners (acupuncturists, herbalists, physicians).”   Diana makes all her products in small batches so that nothing stays on the shelf for very long, although the oil based products have a shelf life of up to three years.    As she formulates new products, there is always something cooking. The tinctures she makes can take up to six weeks to infuse, which also means a lot of patience and organization to keep everything straight!

I asked Diana how people can help her spread the word about her new venture.   “Tell their friends! Everyone knows someone who has either psoriasis, eczema or acne.  Or they have friends who want to use more natural products on their skin in their everyday skin care routine.  Or if they are a practitioner, they may be treating patients with skin problems and could enhance the results of their acupuncture and herbal treatment with topical products.

**Just for your readers, I am offering 30% off their first order.  Just enter the code “bonnie” at check out.  Offer valid until June 30th**”

Filed Under: Acupuncture, Interviews