A matter of prognostic projection
When it comes to a diagnostic question
My pain management skills
Involve very few pills
And no longer my Enbrel injection
Synopsis: I’m a family practitioner from Sioux City, Iowa. In 2010, I danced back from the brink of burnout and traveled for a year doing temporary medical assignments from Barrow, Alaska to New Zealand’s South Island. I’m now working at a Community Health Center part-time, which has come to mean 54 hours a week.
During my senior year of medical school I arranged to get credit for an elective rotation in acupuncture in January of 1979. I studied under a very smart non-Asian internist for a month, and learned the vocabulary and the rudiments.
Before I had passed any Boards or actually obtained a license, I did acupuncture on a friend in a time crunch. I applied a needle in each shin, close to the knee (the name of the point is Su Zan Li, but its nickname means three villages). He responded well, and worked with tremendous efficiency for the next 9 days, turning out top-notch work. The bottom dropped out of his energy three days later, and he slept for the next two days.
In retrospect, I had precipitated a hypomanic episode; his bipolarity would not be diagnosed for many years. Nor did I realize the enormity of the power of those two needles for decades.
High-quality research with acupuncture showed mixed results. A study published in a major journal demonstrated very good results in treatment of the most severe alcoholics (regretfully, the study didn’t detail exactly where needles went nor how they were placed). Another, published in JAMA, showed acupuncture and sham acupuncture equivalent in the treatment of migraine. Many docs point to that study and assert acupuncture has no validity; I look at the same data and conclude that you don’t have to be much of an acupuncturist to treat migraine; put a half-dozen needles anywhere you want and not very deep, on a regular basis and at the end of a year the patient will have half the migraines he/she used to.
I went to my acupuncturist today for a session because I’ve been off Enbrel for three weeks. My sacroiliac joints haven’t fused despite my age, leading my rheumatologist to question the diagnosis of ankylosing spondylitis. He would like to see if my sed rate (ESR) and my C-reactive protein (CRP) go up in the absence of therapy.
I can hope for a misdiagnosis, or for news that my disease has burnt itself out, but as the days go by the pain in my spine grows. I’m now relying on the pain management skills I developed between 1967 and 2000, when I got my first injection.
I can do a lot of things to bring down the level of pain a notch or two; I can’t do anything to make the pain go away completely. When I walked away from the acupuncturist/chiropractor’s office the pain between my shoulder blades had faded by about two-thirds, and I could sneeze without grunting.
Now I have to work on my sleep pattern.
Tags: acupuncture, acupunture for migraine, ankylosing spondylitis, bipolar, C-reactive protein, CRP, ESR, Ho ku, hypomania, Jama, migraine, rheumatologist, sed rate, sham acupuncture, Su Zan Li, three villages