Traditional Publishing Changes

I’ve been working on my series on fat and have been researching a few things so it’s slow going. I didn’t want to miss posting an article from the Book Coach about changes in publishing and includes some numbers on advances.

This is important to acupuncturists who want to write about book, because they are talking about non fiction advances and the changes that are happening. Most practitioners wouldn’t use a “big” publisher, but if you were wondering what kind of money you might make, this is a helpful article.

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.”


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.

Adventures in Chinese Medicine

Adventures in Chinese Medicine is the new book by Jennifer Dubowsky L.A.c, a book on Chinese Medicine, geared towards those patients who want to learn more about the medicine, without having to spend years in acupuncture school.

Dubowsky is originally from Evanston, Illinois and went to Southwest Acupuncture College. After finishing acupuncture school, she returned to Chicago and has practiced there since 2002.

I asked her to share a little bit more about her book. Dubowsky says, “I wanted to share my passion for this work so, my intention for Adventures in Chinese Medicine is to convey the essential ideas and describe some of the well known techniques of Traditional Chinese Medicine in friendly language illustrated with charts, photographs, cartoons, and diagrams.”

Adventures in Chinese Medicine explains common treatments and the history behind them, such as: Acupuncture; Cupping; Moxabustion; and Herbal Medicine. There are also sections that describe unique concepts that are fundamental to Chinese Medicine – Yin and Yang, Qi, meridians, and the five elements. I believe that all people will be able to relate to the discussion of these ideas.

“My target audiences are those who are curious and want to learn more about the practices and philosophy of Chinese Medicine; practitioners who want to educate their patients; and certainly for patients who already love their treatments and want to understand more about how they work.”

While there are few really good books for lay people on acupuncture, as the profession gains traction, there are more books coming out. I asked Dubowsky what made her book unique.

She says, “My book is unique because I made sure that it is enjoyable (as well as informative) and people will be able to connect to the concepts. Adventures is also visually inviting and beautiful. I worked very hard to create a reader-friendly book and I think having a super girl of Chinese Medicine makes it even more cool and fun for the reader.”

The cover stands out, with it’s acupuncture “super girl” jumping towards the reader from the cover, creating interest from the moment it’s viewed on the shelf.  Dubowsky didn’t actually do the drawings. Instead she conveyed the sort of look she wanted to an illustrator who did the actual drawing for her.  She did do the charts and tables and her mother drew a couple of the diagrams.

Writing a book for lay people means really listening to patients. I asked if Dubowsky had any advice for people explaining the medicine to their patients.  Her biggest advice is to “listen, listen, listen” to what the patient is asking and then explain as simply and as clearly as possible.

For those who want a taste of Dubowsky’s style, she writes at Acupuncture Blog Chicago on a regular basis. Talking about her blog, Dubowsky says, “My blog is intended for anyone interested in learning more about Chinese Medicine and good health. As in my book, I try to maintain a writing style that is friendly and approachable.” Dubowsky has been writing her blog since 2008.

I asked Dubowsky how much work writing the book was.  She said, “From conception to publication, this took over two years to finish with writing and re-writing.” She does plan to write some more books but first she feels like she needs a break. Her patients were often involved in the process and were very supportive. Dubowsky says she asked patients for reactions to the cartoons and the topics she covered.

Dubowsky says, “Adventures in Chinese Medicine has been a labor of love, and I hope it is received as such. I think it is truly a one of a kind book, that many people will enjoy and get something from it.”



Target Your Audience

When you write your book, make sure you know how you’re writing for and stick with it. I recently read a psychology book where the author stated in the introduction that he originally planned the book for professionals but it was so useful that they toned down the language so that it could be for either lay people or professionals. I think that was a bad decision.

The early language that introduced the idea was appropriate to both groups.  Neither group had a lot of information about what he was speaking about unless they already knew his technique and philosophy.

The next section was written simply, more for lay people with some added notes that would be appropriate for professionals. As a lay person, the notes were annoying but not bad.  As a professional, I might have been tempted to skip the book because of the simplistic way this was written.

In the final section he promised to talk about how to help each of these categories of people. This is where it clearly became about the professional.  He took one of his categories  and wrote a long and specific treatment plan based on all the expanded knowledge he had on this particular constellation of problems.  After writing several more chapters going more in-depth with the same category of person, he then talks about ways you can generalize for all the other categories.  This is fine for a practitioner, but for the lay person who might have been hoping for some personal insight, this was a let down.

Both categories of readers were ultimately let down by the book.  Understand that no matter what you write, it’s not for everyone.  It targets an audience.  This author, who thought his ideas would be appropriate for lay people and professionals was right. However, the idea that one book would work for both was not.  He’d have done better to write two books. One for lay people and one for professionals.

The most important thing you can do as a professional writing a book based on your knowledge is to target your audience. Stop worrying about the people who don’t fit that category.  You, or someone else, will write the book for them.

When You Need a Professional to Help

Acupuncturists, myself included, seem to have this issue about doing it ourselves.  We think we can create our own websites, our business cards, our own marketing materials our own office decorations. In some cases we don’t really have a choice. Those of us who have practiced for a number of years may have had to create some of these things on our own because they weren’t available.

When it comes to basic marketing messages, Acupuncture Media Works does a good product. Jeffrey’s background as a graphic designer means he has some very professional looking items, including some good looking websites.  But you do have to pay him for his work.

As small business owners, it’s easy to think about cutting corners when trying to work on our own marketing materials. We think we know what looks good, not even realizing how much change a couple of small tweaks by a professional can make.  A couple of weeks ago I was working on the cover for my first fiction book, struggling because it just didn’t look right. My friend Debbie, who is a graphic artist, spent about five minutes, found a font that spoke to her and dashed it off with another tiny little change that I probably wouldn’t have thought about, making the whole cover come together.

I’ve written before about hiring someone who knows websites to design your website. If you do decide to try and do it yourself, at least get someone professional to do graphic design. And have someone on hand who can help you with the technical details.

When it comes to promotional materials, consider getting a graphic artist to do the work.

If you are writing a book about your topic, get a graphic artist to do the cover for you. People really do judge a book by it’s cover.

If you aren’t sure where to go, there are a lot of good graphic designers out there. Remember my friend Debbie who just popped off a design for my novel (which I ended up changing a font because she might have owned it, I didn’t and it had a commercial license that was more than I wanted to pay)? She does freelance graphic design work at Glogirly Design. I know her through blogging about our pets. In the last two years she’s become well known in that community for clean designs with distinctive colors. She’s easy to work with and her prices are very reasonable. She works quickly.  If you need something personal for your business, consider contacting her. You won’t regret it.

If you don’t like her style, then find a designer whose style you do like. Just find someone who knows about graphic designs. These images might be your first contact with a potential client. Make them look professional.

I Want to Write a Book. Now What?

So you’ve decided to write a book.  Or you decided you wanted to write a book three years ago and are still thinking about it.  The problem is, every time you think about it, you start wondering where to start.

Start with your audience.Who is the book for? Are you sharing your expertise with other professionals or are you sharing health tips for your patients? If you’re sharing health tips, will they only be for your patients or for anyone who wants to feel better or has a certain disease?  These questions will help you as you make notes that you can turn into a book outline or, if you are more free spirited, you can work from directly as you write your book.

Knowing your audience will help you with your writing voice.  A book targeted at other practitioners will have a depth and use language that would not be appropriate for lay people.  It’s important to keep that in mind as you write.

Make some notes about topics within your book topic. What sorts of things do you want to share. If you are writing about acupuncture and insomnia, are you going to talk about diagnosis or how to make a diagnosis? This could be one section. Of course another section or within those subsections, you might also have point prescriptions and herbal prescriptions and adjunct therapies that you hope to use.  Finally, you might be talking about the definitions of insomnia. Of course, looking at the notes, you might think it would be smarter to write about insomnia and how it manifests first and then talk about diagnosis second.  This would be a good call.  Notes and outlines are helpful that way.

Looking over your topics and ideas, you can get a feel for what you want to write. How many sections. How many notes to do you have within each of those sections. How much do you think you can write about each subtopic?  This will help you plan out your time for writing.

Now, consider how to set aside some time for writing.  Even if it’s only an hour a week, plan to sit down and write something (no matter how bad) once a week for that hour. Make more note, make an outline, write some chapters or even just write a sentence, no matter what you do during that time, make that time about your book.  At some point you’ll actually have a manuscript.  After that, you can decide what to do next about publishing.

Do You Have a Book Inside?

I realized that it’s been over twelve years since I graduated from Oregon College of Oriental Medicine. Those who graduated with me and shortly after me are becoming masters at the profession of acupuncture.  Many have specialties.  It’s not only possible but even likely that some of my peers have knowledge that should be shared with others.  Some may chose to do it via writing a book.

Writing a book may not be any easier than it ever has been, but publishing a book has never been easier.  Amazon’s Kindle direct and Barnes and Noble’s interface for the Nook make publishing an e-book easier than ever.  Create Space on Amazon allows for easy publishing of print work.  In both cases, you’ll be listed with all the other books on the appropriate websites. It’s like getting your book put in the bookstores immediately.  This is a huge help.

Okay, getting people to notice your book among all the others can be an issue but that once you’re in the store, you’re definitely getting somewhere. Like everything else, knowing your target audience is important.  Are you writing for other acupuncturists or lay people? Knowing that you can more easily target the appropriate people via appropriate marketing strategies.  If you are writing for lay people, the best marketing strategies might be the same ones you use to market your clinic.

In addition to marketing strategies, make sure you have a good looking product. In this case you need a professional looking book. A professional looking book  has a good cover that makes the author and the title stand out.  The print quality of the image is good.  The inside copy is correctly formatted and reads easily with a standard typeface.  Images are professional and well laid out.  The text has quality editing.  There are few typos.  No book is ever completely free of typos, but you want yours to have as few as possible.  An editor is an invaluable resource.

As the profession grows, anyone who has a specialty or success with certain conditions owes it to the profession to share their knowledge.  Don’t hold back because you think you don’t know what you’re doing.

10 Myths About Acupuncture

Book1The best way to learn something is to do it. I wanted to be sure that I had the ability to format a book for any publisher and I wanted to start formatting something with endnotes and table of contents.  To that end, I published by short book, 10 Myths About Acupuncture.

I’ve written this book for the lay person who is interested in acupuncture, but perhaps too afraid to try it. They’ve seen the news and wondered if it could help them but they have a lot of misconceptions.  My goal for this book is for potential patients to feel safe making the choice to try acupuncture.  While the style is a bit more pendantic than I would like, I wanted to make sure that my word choices were exact and my information clear.

I hope that if you have a need to share this information with potential patients, you will think of me.