laptop and stethoscope
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laptop and stethoscopeThirteen years ago I had a panic attack after finishing my last shift as a hospital doctor. I was hyperventilating and shaking. For a few minutes I wondered how I was going to survive without that familiar yet suffocating yoke around my neck that I had been carrying – no, not my stethoscope, but my career as a medical doctor. Then I pulled myself together – and I have never looked back since.

I had spent six years in medical school and three years as a junior doctor. I had witnessed dreadful things, distressing things, without any support from senior doctors. I felt like I was on a conveyor belt to Hell. Something seemed to be missing but I didn’t know what it was. So I enrolled in a Chinese Medicine Bachelor Degree and did not apply for a new job the following year. I sat in lectures about Yin and Yang and learned about the different types of Qi. I spent one year just learning about the hundreds of acupuncture points on the body. I learned about herbs that warmed, herbs that dispelled damp, herbs that invigorated Qi. I had become a Sinophile during medical school, in an attempt to discover my cultural “roots”. Studying Chinese Medicine seemed to be an obvious extension of my journey.

At first it was exotic, but then I began to see the parallels between Chinese and Western medicine. I learned about the influences of the five emotions on the body – especially anger and “over-thinking”. Chinese Medicine taught me to appreciate the impact of lifestyle on health. I also had an introduction to nutrition – a naturopath gave us lectures on vitamins, minerals and wholefoods. I was amazed. Nutrition in hospitals boiled down to serving bacon and eggs for oncology patients, and Sustagen to thin patients.

Gratuitous bacon meme... I couldn't resist ;)
Gratuitous bacon meme… I couldn’t resist ;)

I realised how unwell I was. I was plagued with hay fever symptoms, constant sinusitis, back pain, insomnia, constipation. My diet was terrible and I did no exercise. But gradually, with the dawning of a realisation that I should be taking better care of my health, and the blessing of free time – not needing to work 15 hour shifts several times a week – I started doing more exercise and improving what I ate. I started running. I slowly gave up junk food. My hay fever improved.

But I couldn’t leave Western Medicine behind. I felt there was something I hadn’t finished. I was accepted as a GP trainee after graduating from Chinese Medicine. Two years later, after obtaining my Fellowship, I joined an integrative GP clinic and I am still there, eight years on.

I’ve been on a journey to discover the answers to true wellbeing since I diverted from Western Medicine. Since then I’ve learned so much about nutrition, lifestyle, and the mind-body connection and how to use it. Taking a different tangent opened up my eyes to new paradigms. It was startling. I learned that there was more to medicine than prescriptions. I learned that every human being is a complex and unique creature, and that curing and preventing disease often required more than a drug order. I also learned that there were many situations where drugs saved lives and prevented complications. My job is to know what the situation calls for. I’ve returned to Western Medicine with a new set of eyes.

Now I find I’m moving away from acupuncture because it’s a passive treatment. I still use it in practice and am passionate about establishing rigorous evidence around its’ possible effectiveness. But I believe that active lifestyle changes will make the biggest impact on health in the “worried well” that consult me. Time and time again my advice is to eat less sugar, do more exercise, meditate, practise positive self-talk, go to bed at the same time every night. If patients did these religiously they would rarely need to see me. The other problems are easily fixed – the ones that require a prescription.

I consider myself very fortunate to have a career in Western Medicine. I took a roundabout way back to medicine, but I certainly haven’t ended up in the same place – or perhaps the same place, but with a new vision. If I hadn’t left for a little while, I may not have discovered my vocation – to teach and inspire others to find the answers to health and happiness. (One of the ancient definitions of “doctor” is “someone who teaches“). Inspiration implies I have to be a somewhat healthy role model myself. Now I spend my days and nights learning about health and wellbeing – about healing and nurturing the body, heart, mind and spirit. It’s an amazing and privileged journey and I intend to share it with everyone who wants to come along with me. :)

Photo credit: http://farm7.static.flickr.com/6079/6123892769_9fd6451484.jpg

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In 2012 I was nominated as an “Early Career Researcher” speaker at a colloquium to celebrate 150 years of women in medicine at the University of Melbourne.

While I was incredibly honoured to be nominated, I was somewhat in a panic when my nomination was accepted, because I was newly pregnant – and my presentation was scheduled for 4pm, which is the time of day I usually prefer to be horizontal, and preferably asleep – not presenting to a discerning audience of high-achieving female researchers and scientists!

I made it through the presentation though I was very nauseous, exhausted and generally feeling vile at 8 weeks pregnant. I come on at 9 minutes 13 seconds to talk about “building a bridge between Western and Eastern medicine”. Enjoy! :)

 

 

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Rottenecards_2048171_th2y63gsfyI get asked this question a lot by curious friends and nervous patients. Does acupuncture hurt? Whenever people think of needles, they think of pain. Most people are surprised, and relieved, to learn that acupuncture doesn’t hurt. Most of the time, patients don’t even feel the needle go through the skin. It shouldn’t cause pain, although there is certainly a “needle sensation” described as a discomfort, with different sensations like tingling, numbness, warmth, swelling, or maybe even something close to soreness, but not actual pain. The reason acupuncture needles do not generally cause pain is that:

  • Acupuncture needles are extremely fine – about twice the width of a human hair.
By Xhienne (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
By Xhienne (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
  • They are not designed to cut tissue, unlike the needles used for injections and blood tests.
  • Acupuncturists are not sadists. (Ok I made that last one up… I mean, I am positive none of us are sadists… but I haven’t actually done a study on it. I was just trying to lighten the mood. But I digress).

You do want to have some sensation though, and in Chinese Medicine this is eloquently referred to as a phenomenon called “de qi”, which translates to “The Qi has arrived”. Qi is the life force, the energy that drives everything and is in everything. Acupuncture aims to influence the different types of Qi in the body, perhaps by unblocking it, or directing it to different areas, or increasing it.

Why is de qi important? The prevailing theory is that de qi, or needle sensation, is essential for acupuncture to work. (Though Japanese acupuncture is an adaptation of acupuncture using very smooth needles that do not cause any needle sensation… and many people believe this still works). De qi is believed to be caused by tiny muscle fibres wrapping around the needle when the acupuncturist (gently) manipulates the needle. (Interestingly, acupuncturists can feel de qi as well – it is classically described as the “fish biting on the fishing line”. I’ve felt it at the same time as the patient reports they get the needle sensation. It’s fascinating).

When we sense de qi our nerves do too – specifically, tiny nerves that carry pain signals. These then transmit signals to our spinal cord and different areas in our brain that then will stimulate the release of a cascade of happy chemicals that cause the acupuncture effect. A pleasant cocktail of serotonin, endorphins and other nommy neurotransmitters that can relieve pain, increase well-being, reduce blood pressure, improve sleep… No wonder so many of my patients enjoy that post-acupuncture buzz so much! Hmm…

Photo: http://www.buzzle.com/articles/acupuncture-for-back-pain.html
Take me to my happy place…
Photo: http://www.buzzle.com/articles/acupuncture-for-back-pain.html

In a very unscientific “study”, I have estimated that the number of people I have treated who complained of pain on needle insertion has been four out of hundreds and hundreds (yes, very rigorous science there I agree…) that I have treated. Usually this is because the acupuncture needle has gone into a little hair follicle, or burst a tiny capillary. Removing the needle or adjusting the position of the needle usually fixes the problem.

I hope that has convinced you, please feel free to share with anyone you think would benefit from acupuncture :)

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By Elnaz6 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

By Elnaz6 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
By Elnaz6 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
I had an enquiry from a new patient who was referred me for acupuncture because her baby was in breech position (bottom/legs first). I haven’t done any acupuncture to attempt to “turn” babies in the third trimester, and I thought I would look into it first. It’s one of those traditional techniques that is mainstream practice in China. In fact, women are instructed to perform self-acupuncture at home! A quick search revealed two systematic reviews, one on acupuncture and one on moxibustion. Moxibustion is an interesting Chinese medical procedure where a herb, mugwort, is burnt (causing a very distinctive, but not unpleasant odor) and the warmth from the burning herb is used to warm the acupuncture point. The herb might be attached directly to the needle (hence the needle is warmed) or a herbal stick is burnt and held close to the acupuncture point. There is only one point that is traditionally used, and this is on the side of the little toe. Noone has been able to explain, from a physiological point of view, why this point in particular is effective. However, some researchers theorise that acupuncture might work by increasing fetal movement, hence encouraging the baby to turn itself. Clever! Both reviews conclude that the evidence so far (a handful of trials, but none of them placebo-controlled) is encouraging, but more research is needed, including research on the safety of acupuncture and moxibustion in late pregnancy. However, given that we know that acupuncture is generally very safe, and the alternative might be a Caesarian section, it is probably worth a try.

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There’s been a bit of a flurry of activity recently in my research world, with our fabulous media rep scoring a news item on Channel Ten News, which aired on 9 April 2012. The news team were wonderful, and I was relieved that the whole affair was actually quite laid-back (despite the hours I spent stressing over choosing the right outfit for television the night before. Who would have thought my wardrobe palette just didn’t stand up to appearing on television?) We had over fifty enquiries and counting. It showed nationally, and random friends rang me from across the other side of the country to say they had seen me on TV.

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Lately I’ve turned my hand to writing articles for online sources. I approached Natural Therapy Pages, arguably the largest Natural therapies directory in Australia, about linking to the Acupause study from their article on acupuncture for hot flushes. In return I offered to write several articles on acupuncture for free.

All writing practice is invaluable if you’re a PhD candidate or academic, and I enjoyed the challenges of writing my first article, which was quite different to writing for an academic journal – and more rewarding, in many ways. Within a couple of weeks my article was online, and was shared on Facebook 28 times in 48 hours. The power of social media!

I’m hooked and will be writing more articles, all of which will form some kind of material for my thesis chapters – what a win-win situation. Here’s a link to my very first article on acupuncture and hypnosis for labour pain.

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This is hot off the press. A very recent review on menopause and hot flushes, written by a collaboration of menopause experts including Professor Martha Hickey from our very own University of Melbourne and Royal Women’s Hospital, commented that “Acupuncture may ameliorate climacteric symptoms but good-quality clinical trials are needed.” There is a need for more research into this area that is carefully designed so that it sheds more light on this issue. It’s always good to get validation for what you are doing, but now it’s back to business as usual – the challenge of getting enough volunteers for a clinical trial.

D. F. Archer et al., Climacteric : the journal of the International Menopause Society 14, 515 (2011 Oct (Epub 2011 Aug, 2011).

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That is what I am presumably spending the next six years finding out, though I don’t think I can really claim to answer the question after doing a mere PhD on the topic – but I will hopefully be adding to the “body of evidence”.

For the past eight months I’ve slaved away and written protocols, trained acupuncturists, designed surveys, and seen to every tiny detail that will make this come together. “This” being a large clinical trial, to the tune of 360 women, and requiring more than half a million dollars to run. (Before you get too heated up, very little of that loot is coming to me. In fact, as most academics know, it would be a very sad thing if I was doing this for the money).

The lovely people at the Human Research Ethics Committee (aka HREC – there’s a lot of acronyms in University bureaucracy) at the University of Melbourne have rubber-stamped my application to post on my blog about the trial. So here is the link to our official website.

This project really is “my baby”, being something I conceived in 2008 and gestated as a pilot study (my Masters project). I’m an acupuncturist, and we often see dramatic results in practice, but it can be difficult to know if it was due to our skill and expertise or if it was all a “placebo effect”. (Which some people argue is a large part of the acupuncture experience – and they are probably right).

Women in midlife are probably my largest clientele, and I would be overjoyed if we discovered acupuncture works for hot flushes, because it may just ease the burden that these wonderful women carry – they work, look after partners, look after ageing parents, stepchildren, children, sometimes grandchildren, and they just don’t need the bother of hot flushes.

If you know any women who are postmenopausal, suffering from hot flushes, and who have not had acupuncture in the past, and who live in Melbourne, please point them to my website.

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