Discussion and Diversity

Every now and then I learn something on Facebook. Not from the articles posted there or from the information someone posts but from the way people act.

What I’ve noticed is a growing trend among people who don’t want to engage in discussion but just spout their views. If anyone disagrees these people do a couple of things. They might start an argument and get very hostile. I’m slightly more comfortable with this overt engagement. They are willing to discuss. I’m not saying that hostility is okay but sometimes what comes across in the written word as hostile may not be hostile when someone is sitting around in a group talking. There is no body language to diffuse something. Things get out of control. I’m an admin on three different groups with three very different focuses and you see this now and again. Someone says something that is triggering to the other person and then suddenly things escalate.

The other way people shut down discussion is by blocking another person. Even if that person was not saying anything particularly offensive. Sometimes you get emails about why someone can’t find a thread they were participating in and you realize that person starting the thread blocked them. And if you go back, you see that they might have been putting forth their own views but the other person didn’t want to engage. Even if those views were not stated in a hostile or confrontational manner (no matter how hard I look). And that makes me sad for the world.

We are so divided on so many things. And here people go starting to shut down any sort of meaningful discussion on topics that really don’t need to be divisive. For all that we are supposed to be so enlightened and looking to ourselves for the issue, what I see on Facebook is that people are acting on those triggers and immediately laying blame to others and refusing to hear other sides to a discussion. That’s a problem for me. That’s a big problem because the discussions on Facebook are not life and death. They don’t mean the end of our world. But if we can’t discuss small things online without deciding that we don’t want to hear a voice that speaks differently than ours, how will we ever discuss the big things?

 

Generation Gap

I’m on the other side of the generation gap. I’m 51. It’s not my age that made me stand up and realize that, it was a number of little things. It was realizing that sometimes people were saying things on Facebook that made no sense and I had to ask why. It was having to explain why I said I liked being able to get software more cheaply and easily for a PC than a Mac.

For those too young to remember, back in the 1990s, when real computer nerds like me had Macs, you actually had to go to a store to purchase software or get on a catalog mailing list. Most available software was for PCs and most stores had only an aisle or two  for Mac software. In addition, what software there was typically cost 20 to 30% more than comparable PC software (even if it was by the same manufacturer).  Yes, things have changed.

But what really made me realize I was on the other side looking back, was a young woman stood up at Comic Con. She stood up and talked about how she couldn’t believe anyone thought Nichelle Nichols was a feminist on Star Trek. She was, after all a glorified secretary. Now, point of fact, Lt. Uhura was a glorified phone operator (look it up) and not a glorified secretary. More importantly, she was on the bridge, offering information (if not an opinion) to the captain of the ship. She was not just the wife or mother of someone. She was a strong, unmarried (so we believe) female who had a career and, in 1966 when the show premiered, that was huge.  While I am pleased to say we have come far enough that this has to be explained, I am saddened that those  strides in equality are being forgotten.

There are always things that could have been done better but in 1966, the producers were taking a chance on her. And that’s something that shouldn’t ever be forgotten. I am only informed because I lived it. I am the older generation who took certain things for granted that young people have never heard of. I struggle with things others much younger than I am don’t understand.

I grew up on records and cassette tapes. I dialed phones with a rotary dial and it was great to get a touch tone phone. I worked at places with phones with extra long cords so that you could walk farther from the base (and all the potential tripping and jumping that required).  I typed on a typewriter. I wrote my first stories on typewriters. I submitted typewritten stories only to be horrified when I found a typo when the editor sent it back. Once it was in the title.

I knew how to manage PC DOS as well as MS DOS, but DCL was the command language I was most familiar with. My contemporaries learned Fortran and Cobal, LISP and C. I know Pascal and Basic. I have since learned C#, PHP and of course HTML and CSS. I have used  Amigas (first multiprocessing machine), Macs and now PCs. According to Huffington Post I should be able to program my DVR or my TIVO to record a show, but I no longer know how to do that. I don’t watch much television  and I let my husband program those systems. There is just so much to re-learn.

I still hand install WordPress because I feel more secure that way, although I am often questioned. I don’t sign up for things that I don’t want to. I am suspicious of online software that requires I pay monthly, particularly when it is accounting software.  I am told that nothing is secure by young people. And I remind them I lock my doors too even though that’s perhaps not completely secure.  There are things I learned. While nothing is secure, I don’t know why I shouldn’t lock my doors, why I shouldn’t question who wants my credit info and make choices deliberately.

The worst thing? It’s having the discussion with a twenty year old online and only after you try to explain something obvious do they say something that makes you realize how young they are. Chances are, by the time they are my age, there will be constant images and you’ll no longer hide behind a faceless avatar offering you fake age. Of course the old folks will hate having to show off their older faces and have people know they are elders though. At least I hope so. Because right now, I can show off my cat’s face on my avatar and no one needs to know what I look like this morning.

Recap 2013 and Looking Ahead

IMG_2549bklac2013Last year I had a list of things I wanted to do and I think I did fairly well in terms of meeting my goals.

  1. I wanted to write at least 5 books this year.  Check.  I actually managed seven new rough drafts
  2. I want to indie publish 4 books. Check. I did one under Bonnie Koenig, EAMP for potential acupuncture patients, three full length books under Bonnie Elizabeth and published one short story. I also finished a short story that was accepted into an anthology.
  3. I want to take at least one class from Dean Wesley Smith. Check. I actually took three classes. Totally worthwhile!
  4. Changing this site to an editing site. Check. I have a bit of a question on this as I seem to have lost the vision for that.
  5. I want to do more editing. No. I was so busy writing that I wasn’t that interested. I didn’t market. I guess that means that with the above, I wasn’t that interested.
  6. Working out a writing coaching program. Not even close
  7. Taking four of six virtual retreats with Mark at Heart of Business. Check. I think I did five!

So what are my goals for next year? I think I want to do more writing but also offering myself time to work with what I’ve done. I also need to market at little more. Clearly I’m more interested in writing than in editing and I’m okay with that.

So for 2014 my goals are:

  1. I want to indie publish 3 books. Lower than last year but I want to make sure I stay on top of quality and perhaps spend time creating systems that will let me feel good about working faster in future years.
  2. I want to take at least four out of six virtual retreats with Mark at Heart of Business. I find this very important to me
  3. I want to take some more classes with Dean Wesley Smith. I already have two of them picked out and I expect this will be an easy goal to make.
  4. I want to join at least one writing organization.
  5. I want to write more short stories and I want to submit at least four of them to magazines (plural) I have no goals about getting them published. I just want the experience of getting them out there
  6. I want to deconstruct a book in a particular genre and write one in that genre
  7. I want to write at least five more books.
  8. I want to change the look of my publishing site.

So there I am. I am also thinking I’ll probably do a little more photography for acupuncturists. I’m finding that although I don’t make much I do get a little money in pretty regularly selling acupuncture products on Zazzle. It’s not a living wage but it is steady and I want to increase that hope. We’ll see.

What are your goals?

What is Fat?

I was going to start on what I saw as the potential imbalances that might cause someone to be fat but being thorough, I wanted to define fat before doing so.

I started with Giovanni Maciocia’s Foundations of Chinese Medicine (yeah, really the older one).  In the index, there is no reference to the words,”fat”, “overweight”, or “obesity”. So I read through the organ systems, paying particular attention to the spleen and stomach areas. No reference to fat. I recall reading somewhere that fat was dampness so I also paid particular attention to any damp related pathology as well as triple warmer. Nothing on “fat”.

Next, I looked through the pathologies of each organ, once again paying particular attention to spleen and stomach. Not one pathology references “fatness” or “obesity” as a symptom.

Finally I got to his chapter on the five constitutional types.  Earth types were drawn as being rather heavy and in fact, it talks about earth types as having a large stomach (looks “fat” in the drawing) as well as large muscles. Water too appears to carry some extra weight all over and is considered a constitutional type. There is no mention of defining this person as fat or treating a water type for being fat.  This is considered a constitutional type that is built this way, unlike the wood type that does look naturally slender.

I also looked in Maciocia’s Practice of Chinese Medicine. Again there is no listing for “fat” or “obesity” in  any of the syndromes or in the index. He does talk about the excess dampness under the skin being oedema but that is different from “fat”.

Of course, overeating is mentioned and the distention of the stomach and fullness that can cause illness when one overeats. Again, this is different from being fat given that the vast majority of fat people did not get there because they ate too much.

This leads me to wonder what people are reading when they talk about Chinese Medicine and obesity. I talked to a friend who is very well versed in Classical Chinese Medicine. His response was that he doesn’t recall reading anything about fat. The ancient Chinese were much more likely to have starvation and famine and underweight was probably a bigger problem. As to treating fat, well you’d go by the imbalances and once in balance the body would find it’s own normal weight (whatever that is).

There is discussion of dampness residing in the muscles, but I’m not sure that it manifests as fat so much as it manifests as that early morning muscle stiffness.  After all, colds often start out that way as well.  It could also be referring, as Maciocia did, to oedema under the skin.

That means that any acupuncture  practitioner who is determining if someone is fat is doing so by modern standards.  So that leads us to BMI, which of course really doesn’t mean anything. BMI is as arbitrary and inaccurate as height/weight charts.  In fact, in 1998, the BMI charts changed so that people in the normal range suddenly became overweight because the classification changed, not because they gained any weight.  Additionally there are a variety of recommendations for different BMI classifications as to what is normal versus overweight.

The other option is the waist/hip ratio. This is great for those of us who gain weight on our hips and thighs. However, if like most earth and water types, one puts on weight around the belly, one will still be considered fat even if it is normal for the person’s constitutional type. I’m not sure what I am. I have a BMI of 33 and a normal hip/waist ratio so do I split the difference and come out “overweight”? Slightly fat?

Even using modern standards, there are no set standards for the point at which a normal person becomes fat. Like beauty, fat, for the most part appears to be a cultural manifestation.  Now I haven’t had the time to look through everything in terms of defining fat to see if there is some objective standard. However, I’ve done as more or more research into this than the vast majority of people who claim to treat “fat”.  For me, this offers a level of concern over why any acupuncture practitioner, who is treating the whole person, would want to treat someone for being fat, when no one has asked what is too much. After all, everyone has some fat, that’s normal.  The question becomes when it is it abnormal from a health perspective versus abnormal from a cultural sense of what is beautiful? That’s not something we can tell by looking at someone and I’m not sure there is anything in the classics that offers me a place to start.

 

My Big Fat Rant

Recently there was a discussion on Facebook about acupuncturists treating people for obesity. I’d like to point out that treating someone for obesity is not treating someone for a health condition. People argue about this point but it’s true. Fat people can be healthy. Imagine.  They can also be fit. So the idea of bringing in people who are otherwise healthy for health care seems rather unethical to me.

Now, I and a few others who were pro-size-acceptance were asked to stay off the thread so that those who wanted to could learn what other practitioners found to be  effective for working with weight loss. Apparently pointing out that obesity was not a health problem and that we needed to treat the person rather than the “weight” was not considered a useful tip.

The fact is, fat people do go to acupuncturists. Some of my patients were fat. Some of them were not. Many of the fat and thin people had the same health issues. Many of them had the same overlapping constellation of disease patterns, that may have manifested in slightly varied symptoms. If I didn’t need to weigh my thin patient, why should I weigh my fat one?

Several practitioners talked about obesity as if it in and of itself was the problem.

They talked about gathering BMI measurements and taking weight measurements to help them assist the client in promoting better health. However, obesity is not in and of itself a problem. It is often correlated with other problems. Helping those other issues that may go in tandem with obesity is great if the patient comes to you for those issues. If you are actually treating the root cause, rather than focusing on the symptom, you might end up having a person who loses weight on your watch and maybe they even keep some of it off. To say that a fat person is unhealthy just because they have a large BMI is not true.

Practitioners were often quick to point out to the size acceptance people that we were wrong.

There was no scientific evidence used to back up the claims that we were wrong. It was only “common wisdom” that was used and everybody knows “that”. That’s  not an effective argument. Please point out the science behind what you think is wrong. Until then, I’m going to say they’re right. My links have science behind them and they quote it.

I am particularly disappointed that such arguments came from acupuncturists, because “everybody knows” acupuncture has no science behind it.

There were many suggestions on the thread about lifestyle changes, mainly diet and exercise.

Diets don’t work. Neither does adding exercise. Do I really need another link to Shapely Prose?  It’s healthier to maintain a stable weight than it is to lose a lot of weight only to regain it a few years later. That should be obvious to practitioners who are about balance. However, let’s remember balance is not static, it is something that fluctuates from time to time. The most stable systems can adjust and re-adjust on a regular basis. These systems, however, make small adjustments. That means that small weight fluctuations, like one or two or five pounds that get gained and lost are far healthier than fifteen or fifty pounds that get lost and then gained.

There were a few suggestions about measuring BMI.

Apparently, the BMI is “objective” and because of that, taking it and reporting it isn’t a judgement but merely a fact and therefore patients will hear the news that they are fat and will do something about it.

First, BMI measurements are an arbitrary measurement. They’ve been changed overnight so that many normal weight people became overweight, just because someone decided to change the categories.

Second of all, fat people know they’re fat. You don’t have to give them an objective reading. This will not be motivating. Trust me, all fat people are motivated to lose weight and if you actually have an unmotivated fat person sitting in your office, that person isn’t motivated because they’ve failed so many times they don’t want to get their hopes up again.

Or you may have a fat activist in your office, in which case you might actually learn something if you listen to them.

There is an insistence that there is a general consensus that being overweight or obese leads to health issues.

This is not true. At all. Except among people who sell diet products. As to the other side of that argument, please refer back to Kate Harding’s site.

One person suggested that obese people don’t want to change.

Well, maybe. Not everyone does. They may already be aware that those changes you want them to make don’t work. They may have tried things you’ve never considered and they are still fat. So why should they change? Additionally, if they are there for health reasons, maybe dealing with the illness is not the best time for major lifestyle change. It may be that they’re expending all their energy just to exist and get to their various doctor’s appointments.

Now, let’s consider that during the thread a number of people talked about how diets don’t work (see above) and that weight loss may not be as easy as you’ve tried to make it sound, and yet you refuse to comment on any of the great links offered. Can I suggest that perhaps you don’t want to change either?

In order to help a sick person, acupuncturists need to address diet and lifestyle.

I don’t disagree with that in general. I do disagree with suggesting people need to eat less or eat lower calorie foods. In fact, I suspect many of my fat patients actually need to eat more. As to how much change needs to be made, perhaps you need to start working on the acupuncture side of that and making small suggestions after finding out about the current lifestyle first rather than looking at someone and deciding what their lifestyle must be.

According to one person, acupuncture can help people get to a mental and spiritual place to make the “needed changes” in lifestyle.

I have no words. For this I consulted Ragan Chastain at Dances with Fat and  who said, “This is problematic on a number of levels, first of all, if you think that you can tell from someone’s body size that they need to make spiritual changes, in fact if you are under the impression that body size gives you any information other than the size of the body and your personal attitudes about bodies that size, then I urge you to refer your fat patients to another practitioner until you are able to properly address your prejudices and stereotypes around fat bodies.

“People are many different sizes for many different reasons, there are healthy and unhealthy people of every shape and size, and healthy habits and spiritual balance are not different for different body sizes.  If you run an evidence-based practice you already know that there is no weight loss technique shown to work for more than a tiny fraction of participants. ”

I am troubled by the lack of size acceptance among many practitioners because as acupuncturists we are uniquely suited to help all people get healthy.  It’s  a medicine that insists we treat the root cause. The root cause of  a fat person’s health problems is not being fat. Fat is a symptom. Consider that most women, and even some men (and the percentage of those men is growing) have been dieting off and on for years. In addition to pure caloric starvation, the body is also getting a lot of low calorie fake foods that have minimal nutrition and lots of chemicals that may actually exacerbate the problem. The diabetes and heart disease and hypertension may have less to do with the excess weight and more to do with the excess dieting.

I have information about my own health that I’m willing to share, but that may need to come in another post, because to see me, a fat-ish woman and tell me to eat less would be exactly the opposite of what my doctor told me. And yeah, we did blood work and plenty of tests. Oh and did I mention my doctor is a naturopath? I will talk more about that in a related post. I would also like to address the energetics of being fat in our world, which is a lot more complex than addressing just the spleen. But that’s yet another post. In fact, the combination of all of my commentary might end up being a book.

I’ll leave you with more words from Ragan. “If you want to work appropriately and effectively with fat patients, then I encourage you to think of them exactly like your thin patients, only bigger.  Explain that you can help them have their best possible health, and that health and body size are not the same thing.  Encourage them to pursue healthy habits and allow their body size to settle where it will, rather than attempting to manipulate their body size through food, exercise and acupuncture.

“The only changes you need to make are to your practice – make sure that you have chairs without arms, oversized tables and/or wings to make them wider to accommodate broad-shouldered and fat patients, and work on identifying and eradicating any prejudice that you might have against people of a certain size.  Finally, help your patients see that the social stigma to which they are currently subjected, which is of course horrible for their health, is not deserved and that the solution to social stigma is not weight loss, but ending social stigma and the problem lies not with their bodies, but with a society that has developed prejudice against it.”

And if you want to know more, in addition to her blog, which is a great read, Ragan does speaking engagements. This could be a great learning experience for a group of local healthcare providers who want to better serve their clients of size.

Honoring Our Differences

It’s easy to become dogmatic about things we love. However, not everything works for everyone and every single person needs to find their own way.  I re-remembered this a couple of times yesterday.   Once was when someone posted about a health concern on a Facebook forum and another friend, who has no medical background to my knowledge, immediately posts some information about what to do, that contradicted what this person’s healthcare provider recommended.  As a knowledgeable person about complementary health, I know what was recommended. My friend has contacted me off the internet about her health concerns and asked questions about the treatment plan.  I was quite put off by the information given from the other friend not only because it was incorrect for the person it was recommended to, it was   irresponsibly posted, as if this was the only way to do something, followed up with a chatty, “Call me and I’ll get you fixed right up.”

Yeah.

I re-remembered it again as I talked to another friend. We had gone through a coaching program together, which I feel was quite invaluable. She’s moved on to work with a different coach in a different program which she is very excited about. It seems to be working for her. I still feel myself tightening up, wanting to defend the first coach as a the preferred choice, although clearly, while the initial program helped me a great deal, it didn’t do as much for her.

I am reminded we each have our path.  This is true for everyone. It is true for our patients, that might need another practitioner or a different modality. It is true for our friends and for ourselves.  As humans, we are each unique with different paths to walk in all areas of our life. Sometimes it becomes hard to step back and not defend one’s own choices when they have worked for you.  Sometimes it’s important to do so.

Hiring a Locum Tenens

The hardest part of vacation is finding someone to cover.  Practitioners who share space with other acupuncturists may have an easier time of this.  However, if both practices are busy, patients may not get in at the times they need or as frequently as they need.

Most people willing to work as locum tenens are acupuncturists who are just starting out.  Many of these people are very capable.   More senior practitioners may have concerns about leaving their practice in the hands of someone who is just starting out.  There are fears about the other acupuncturist trying to “steal” their patients.  They may also fear that the other practitioner will make an error of judgment and the patient will stop treatments.

There is no way to guarrantee that this won’t happen.  Know who your locum is.  Know what sorts of things they are best with.   Make sure those are the patients they see.  If you have a good relationship with your patients to begin with, it’s unlikely that a locum will be able to “steal” them away.  If the acupuncturist you have covering for you really does have special knowledge or insight into a particular patient’s condition, you may also want to consider whether sending the patient to this other person might be in the best interests of the patient, even if it is not in your best financial interest.

Very often when someone covers for you, you have them there whatever days they can be available.  They may not have as many days as you would like.  It’s best for everyone if you have only one person at a time cover your office if at all possible. Your patients are already seeing someone new.  They may be uncomfortable with the new person.  It’s not fair to have multiple new people in your office, changing the treatments each time.  Even if you work very hard to have someone do the exact treatment you did, it will always come out a little differently.  Every acupuncturist has their own style.

The most important thing is that you find someone who can fit in with your office.  The locum may not do the same things you do, but their style complements yours in a way that is not too disruptive to the patient.  This can involve meeting with the potential locum, perhaps even being treated by them.  Of course, knowing you are leaving your office in the hands of someone else can be scary.  Consider having them in for one day before you’re going to be gone.  Get feedback from the patients who were seen by that person.

No one can be available all the time. Everyone needs down time. Patients need care.  At some point there’s a good chance someone will have to cover your practice.  Take the time to find the right person.  Keep your expectations realistic.  Then enjoy your vacation.

 

Struggle and Ease

As I work on my art business I am finding that I struggle with the acupuncture side of things more.   There seem to be fewer opportunities for me and those that are there seem like so much more work.  I believe in my art as a vehicle for expanding the reach of acupuncturists.  I believe that what I have to say has value but it is a struggle.

I have other artwork that just seems so much easier to work on and I have more reach.  However, there are more people doing that sort of work so although I have more reach, I also have more competition.  It also doesn’t seem quite as important.

So it is something I have to ask myself.  How important is the ease of work? Is it easy because I love it more? Maybe.  I don’t have all the answers.  As I reflect on this internal struggle and uncertainty, it feels rather universal.  How often to do we think we are led to something because it feels so easy?  Is that really the sign that we are led? Is it really easy or does it feel that way?  Are there always questions along a path.  How do we know what we need to focus on?  What I do know is that this isn’t an either or proposition.  It’s merely the question of what gets focused on today. There will be other things to focus on later.   There may be some of the same choices or there will be new ones.  It’s just a matter of what is happening in the universe.

Why Do I Feel like Acupuncture has to be Serious?

Heart CenteredI’m working with Mark Silver’s Heart of Business year long course this year.  Last week our coaching call was with Jason Stein, who works as a coach with Mark as well as working with Oregon College of Oriental Medicine’s alumni.   Jason started the call with a full minute of laughter.  As I giggled quietly in the background I kept thinking that I really needed to improve my heart qi because I was quite jealous of those could laugh loudly throughout the full minute.  When I tired of my quiet giggle they made me laugh more because of the sheer joy that came from the sound of laughter.

Something else came up for me in that call.  I work on artwork for acupuncturists and I started the class thinking I wanted to focus on that. After that call I realized that this blog and this work is harder for me than the writing I do on my cat blog.  A big part of the reason was because this isn’t as fun.  I feel like I have to be serious when I talk about acupuncture.  I don’t know why.  I feel like in writing something valuable for acupuncturists I have to have some thought provoking and useful post.  I can’t just post the latest Frank and Ernest cartoon that shows them looking at a picture of someone lying face down with needles in their back saying how much back stabbing when on in that school.

Part of that is the fear that such jokes offend people.  The other part is that it feels like it’s not appropriate as a way of offering information.   On the other hand, I am a huge believer that if you can’t laugh at something there’s a problem.  Yes I do laugh at acupuncture but not often among acupuncturists.  When I have patients who were really worried and nervous and it seems appropriate my approach would be to say if it hurt was to “Scream loudly so everyone will know.”  It was such an unexpected response to the fears that they were usually too busy laughing to feel the first insertion, at which point I’d chide them for not screaming loudly.  Most patients were surprised that I had done anything.

Fact it, acupuncture is an energetic medicine that current science can’t quantify in the way the people of the US likes things quantified.  So it’s this strange medicine where people who are already in pain have a bunch of needles poked into them (doesn’t that hurt more?) to get out of pain.  And no one really knows how it works. Acupuncturists do but they can’t put it into terms that Westerners get, usually.  That lack of understanding and that fear of being thought foolish is another reason there is so little humor around acupuncture.   Acupuncturists aren’t out making jokes about their profession.  They want to be taken seriously.

Oddly, the most serious place I worked, an animal hospital, where we were helping people make life and death decisions had more joking around than any place else I’ve ever worked. There was no humor too black or too ironic for the veterinary clinic.  In fact, we had a staff holiday party in a restaurant once.  We were asked not to do it again as everyone seated around us left and many complained about our inappropriate dinner conversation.    We even thought that was funny, if a bit embarrassing.

Why did that staff laugh at things that shouldn’t be laughed at?  Because what else do you do?  As Kurt Vonnegut famously said, if you don’t laugh at it, you’ll cry.  Maybe I need to start realizing that the best way to be taken seriously is to let my hair down long enough to laugh at what I do as an acupuncture practitioner.  How can I be “heart centered” if I don’t laugh? The challenge, of course, is how to lighten the tone of an acupuncture blog like this one.

I guess that’s something we’ll all find out, won’t we?

Delight

Delighted CatI tend to think of delight as joy.  How often do we allow ourselves to just do something we really love and take delight in that moment?  How much do we really delight ourselves?

I tend to get caught up in work and in worrying that it is easy to forget to find something that is just delightful and fun.  It exists and it is there.   Remember that the more delight you have in your life, the more that will carry over into your business.  Customers will see that and take their own delight in the small things you do.